Provider Demographics
NPI:1225044290
Name:MCCUISTION, RODGER LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:RODGER
Middle Name:LEWIS
Last Name:MCCUISTION
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 SLIDE RD
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-2837
Mailing Address - Country:US
Mailing Address - Phone:806-794-6686
Mailing Address - Fax:806-794-2433
Practice Address - Street 1:7805 SLIDE RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-2837
Practice Address - Country:US
Practice Address - Phone:806-794-6686
Practice Address - Fax:806-794-2433
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice