Provider Demographics
NPI:1306089990
Name:DEAN, DEREK LANGFORD (DDS)
Entity type:Individual
Prefix:
First Name:DEREK
Middle Name:LANGFORD
Last Name:DEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1422
Mailing Address - Country:US
Mailing Address - Phone:970-241-1313
Mailing Address - Fax:970-245-5202
Practice Address - Street 1:2552 PATTERSON RD
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1422
Practice Address - Country:US
Practice Address - Phone:970-241-1313
Practice Address - Fax:970-245-5202
Is Sole Proprietor?:No
Enumeration Date:2009-04-12
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CO100501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04609751Medicaid