Provider Demographics
NPI:1740533231
Name:DEMAREST, DUSTIN JOSEPH (MBA)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:JOSEPH
Last Name:DEMAREST
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 WISCONSIN CIR
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50014-3974
Mailing Address - Country:US
Mailing Address - Phone:515-203-1152
Mailing Address - Fax:
Practice Address - Street 1:1306 WISCONSIN CIR
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50014-3974
Practice Address - Country:US
Practice Address - Phone:515-203-1152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-21
Last Update Date:2012-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171WH0202XOther Service ProvidersContractorHome Modifications