Provider Demographics
NPI:1790078509
Name:DEAN, JENNIFER (DMD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5531 CANCHA DE GOLF
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92091-4042
Mailing Address - Country:US
Mailing Address - Phone:858-367-3058
Mailing Address - Fax:
Practice Address - Street 1:5531 CANCHA DE GOLF
Practice Address - Street 2:SUITE 102
Practice Address - City:RANCHO SANTA FE
Practice Address - State:CA
Practice Address - Zip Code:92091-4042
Practice Address - Country:US
Practice Address - Phone:858-367-3058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist