Most Relevant Information
Provider Data
| NPI Number: | 1003572124 |
| Provider Name: | DUSTIN ROSE |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/12/2021 |
| Last Updated: | 11/12/2021 |
Provider Practice Location
104 OWENS ST
LEXINGTON
OK
730519572
Practice Location Phone/Fax
| Phone: | 4058375821 |
| Fax: |
Provider Mailing Location
104 OWENS ST
LEXINGTON
OK
730519572
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |