Provider Demographics
NPI:1457846958
Name:DEEM, CYRUS AUSTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CYRUS
Middle Name:AUSTIN
Last Name:DEEM
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 1:100 W VAN TREES ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-1564
Mailing Address - Country:US
Mailing Address - Phone:812-254-5011
Mailing Address - Fax:
Practice Address - Street 1:100 W VAN TREES ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-1564
Practice Address - Country:US
Practice Address - Phone:812-254-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012967A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist