Provider Demographics
NPI:1760745756
Name:ANDREW J DEAK & ASSOCIATES INC
Entity Type:Organization
Organization Name:ANDREW J DEAK & ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JUSTEN
Authorized Official - Last Name:DEAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:440-667-2224
Mailing Address - Street 1:19657 HILLIARD BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-2926
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3730 ROCKY RIVER DR
Practice Address - Street 2:SUITE 1
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4044
Practice Address - Country:US
Practice Address - Phone:216-251-8787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-24
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0225131223G0001X
OH0223431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty