Provider Demographics
NPI:1790099091
Name:DEAN, DAVID RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RYAN
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 1:411 STRANDER BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2924
Mailing Address - Country:US
Mailing Address - Phone:206-575-3326
Mailing Address - Fax:
Practice Address - Street 1:411 STRANDER BLVD STE 204
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2924
Practice Address - Country:US
Practice Address - Phone:206-575-3326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE601715961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice