Provider Demographics
NPI:1033238167
Name:DEAN, DEANNA MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:MICHELLE
Last Name:DEAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 CORPORATE DR.
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666
Mailing Address - Country:US
Mailing Address - Phone:512-353-2727
Mailing Address - Fax:512-353-2729
Practice Address - Street 1:401 E. WHITESTONE BLVD.
Practice Address - Street 2:STE. C 105
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-260-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice