Provider Demographics
NPI:1447486485
Name:JANSSEN, DUSTIN SEAN (DDS)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:SEAN
Last Name:JANSSEN
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 1:7515 QUAKER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5308
Mailing Address - Country:US
Mailing Address - Phone:806-796-2408
Mailing Address - Fax:806-686-6246
Practice Address - Street 1:7515 QUAKER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5308
Practice Address - Country:US
Practice Address - Phone:806-796-2408
Practice Address - Fax:806-686-6246
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX246011223P0221X
NMDD31381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3196933Medicaid
TX319692502Medicaid
TX319692501Medicaid