Provider Demographics
NPI:1922209741
Name:DINH, DUSTIN P (DDS)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:P
Last Name:DINH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 S AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7835
Mailing Address - Country:US
Mailing Address - Phone:512-863-2303
Mailing Address - Fax:
Practice Address - Street 1:1950 S AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7835
Practice Address - Country:US
Practice Address - Phone:512-863-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23229122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1996637OtherUNITED CONCORDIA PROVIDER #