Provider Demographics
NPI:1114647013
Name:DEAN, CEDRIC (CPP)
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:CPP
Other - Prefix:MR
Other - First Name:CEDRIC
Other - Middle Name:
Other - Last Name:DEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CPP
Mailing Address - Street 1:5502 MCCHESNEY DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-7188
Mailing Address - Country:US
Mailing Address - Phone:704-492-5509
Mailing Address - Fax:
Practice Address - Street 1:1712 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-7151
Practice Address - Country:US
Practice Address - Phone:704-492-5509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021877201171WH0202X, 405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
No171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000005049292OtherDMV
NC1497473086OtherPRIVATE INSURANCE