Provider Demographics
NPI:1609969021
Name:SCOUMIS, DEAN R (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:R
Last Name:SCOUMIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CONSTANTINE
Other - Middle Name:R
Other - Last Name:SCOUMIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2884 E HARDIES RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8444
Mailing Address - Country:US
Mailing Address - Phone:724-444-1366
Mailing Address - Fax:
Practice Address - Street 1:2884 E HARDIES RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GIBSONIA
Practice Address - State:PA
Practice Address - Zip Code:15044-8444
Practice Address - Country:US
Practice Address - Phone:724-444-1366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027245-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice