Provider Demographics
NPI:1629670716
Name:ALLEN, DUSTIN JAMES
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES
Last Name:ALLEN
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 1:5000 S NEVADA AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2290
Mailing Address - Country:US
Mailing Address - Phone:605-740-0955
Mailing Address - Fax:
Practice Address - Street 1:5000 S NEVADA AVE APT 103
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2290
Practice Address - Country:US
Practice Address - Phone:605-740-0955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)