Provider Demographics
NPI:1740752518
Name:DEXTER, ROLLIN ROSS (ATHLETIC TRAINER)
Entity Type:Individual
Prefix:
First Name:ROLLIN
Middle Name:ROSS
Last Name:DEXTER
Suffix:
Gender:M
Credentials:ATHLETIC TRAINER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2855 NW CLEARWATER DR
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-9469
Mailing Address - Country:US
Mailing Address - Phone:541-815-4422
Mailing Address - Fax:541-355-4010
Practice Address - Street 1:2855 NW CLEARWATER DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-9469
Practice Address - Country:US
Practice Address - Phone:541-280-5389
Practice Address - Fax:541-355-4010
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAT-6352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer