Provider Demographics
NPI:1326781360
Name:LUSH, DALLON
Entity Type:Individual
Prefix:
First Name:DALLON
Middle Name:
Last Name:LUSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 COURTNEA LN
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3640
Mailing Address - Country:US
Mailing Address - Phone:931-581-0330
Mailing Address - Fax:
Practice Address - Street 1:6431 FANNIN ST RM 5.170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1501
Practice Address - Country:US
Practice Address - Phone:713-500-5116
Practice Address - Fax:713-500-0648
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program