Provider Demographics
NPI:1699815746
Name:DEAN, JOHN CARTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CARTER
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:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:VA
Mailing Address - Zip Code:24521-0006
Mailing Address - Country:US
Mailing Address - Phone:434-946-7507
Mailing Address - Fax:434-946-7507
Practice Address - Street 1:698 SOUTH MAIN ST.
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:VA
Practice Address - Zip Code:24521-0006
Practice Address - Country:US
Practice Address - Phone:434-946-7507
Practice Address - Fax:434-946-7507
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA052871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA144563OtherANTHEM PROVIDER ID