Provider Demographics
NPI:1225432388
Name:JOHN DEAN DDS PA
Entity Type:Organization
Organization Name:JOHN DEAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-771-2911
Mailing Address - Street 1:2524 CRESTWOOD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7648
Mailing Address - Country:US
Mailing Address - Phone:501-771-2911
Mailing Address - Fax:501-758-2078
Practice Address - Street 1:2524 CRESTWOOD RD STE 2
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7648
Practice Address - Country:US
Practice Address - Phone:501-771-2911
Practice Address - Fax:501-758-2078
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN DEAN DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
AR3118332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment