Provider Demographics
NPI:1629781992
Name:RHOADES, DUSTIN BRETT
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:BRETT
Last Name:RHOADES
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 1:83 BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-3049
Mailing Address - Country:US
Mailing Address - Phone:573-480-4581
Mailing Address - Fax:
Practice Address - Street 1:83 BUCKEYE RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3049
Practice Address - Country:US
Practice Address - Phone:573-480-4581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman