Provider Demographics
NPI:1619543832
Name:KNOWLES, DUSTIN
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:
Last Name:KNOWLES
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 1:519 LOCUST HILL DR
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322-1608
Mailing Address - Country:US
Mailing Address - Phone:318-780-6378
Mailing Address - Fax:
Practice Address - Street 1:2107 JERGENS RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404-1227
Practice Address - Country:US
Practice Address - Phone:318-780-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-28
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance