Provider Demographics
NPI:1073687711
Name:DEAN, JEFFREY S (DDS, MD, FACS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:S
Last Name:DEAN
Suffix:
Gender:M
Credentials:DDS, MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 OAK TREE LN
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5095
Mailing Address - Country:US
Mailing Address - Phone:605-242-0107
Mailing Address - Fax:605-242-0145
Practice Address - Street 1:301 OAK TREE LN
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049
Practice Address - Country:US
Practice Address - Phone:605-242-0107
Practice Address - Fax:605-242-0145
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA090071223S0112X
SDD10131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1548304710OtherBC/BS OF IA
SD1548304710OtherBC/BS OF SD
IA1548304710Medicaid
NE91201365400Medicaid
SD1548304710Medicaid
IA1548304710Medicaid