Provider Demographics
NPI:1427628296
Name:SAMBLANET, DUSTIN ALLAN (RT ( R)(CT)(BD))
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:ALLAN
Last Name:SAMBLANET
Suffix:
Gender:M
Credentials:RT ( R)(CT)(BD)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5372 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-8828
Mailing Address - Country:US
Mailing Address - Phone:330-575-3424
Mailing Address - Fax:
Practice Address - Street 1:5372 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-8828
Practice Address - Country:US
Practice Address - Phone:330-575-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5254002471C3402X, 2471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography