Provider Demographics
NPI:1649837436
Name:FORD, DUSTIN JAMES
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JAMES
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DUSTIN
Other - Middle Name:JAMES
Other - Last Name:BEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1021 4TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-2433
Mailing Address - Country:US
Mailing Address - Phone:661-765-7025
Mailing Address - Fax:661-765-7045
Practice Address - Street 1:1021 4TH ST STE B
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-2433
Practice Address - Country:US
Practice Address - Phone:661-765-7025
Practice Address - Fax:661-765-7045
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator