Provider Demographics
NPI:1659807055
Name:HUNTSMAN, DUSTIN CHRISTOPHER (DPM)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:CHRISTOPHER
Last Name:HUNTSMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-7735
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:426 BEECHER RD STE A
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3506
Practice Address - Country:US
Practice Address - Phone:614-939-9330
Practice Address - Fax:614-939-9299
Is Sole Proprietor?:No
Enumeration Date:2017-05-04
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003989213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery