Provider Demographics
NPI:1114365475
Name:CONSTANTINE, DEAN
Entity Type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:CONSTANTINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 SW 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-5716
Mailing Address - Country:US
Mailing Address - Phone:954-376-3120
Mailing Address - Fax:
Practice Address - Street 1:4045 SW 139TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-5716
Practice Address - Country:US
Practice Address - Phone:954-376-3120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study