Provider Demographics
NPI:1558525667
Name:DIAL, DUSTIN BRENT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:BRENT
Last Name:DIAL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6076 STETSON HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3562
Mailing Address - Country:US
Mailing Address - Phone:719-637-2079
Mailing Address - Fax:719-314-1304
Practice Address - Street 1:6076 STETSON HILLS BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3562
Practice Address - Country:US
Practice Address - Phone:719-637-2079
Practice Address - Fax:719-314-1304
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist