Provider Demographics
NPI:1598883118
Name:ELLEDGE, DEAN ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:ALAN
Last Name:ELLEDGE
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 1:650 E 25TH ST
Mailing Address - Street 2:#277
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2716
Mailing Address - Country:US
Mailing Address - Phone:816-235-2121
Mailing Address - Fax:816-235-5526
Practice Address - Street 1:650 E 25TH ST
Practice Address - Street 2:#277
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2716
Practice Address - Country:US
Practice Address - Phone:816-235-2121
Practice Address - Fax:816-235-5526
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0140501223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics