Provider Demographics
NPI:1790103141
Name:STEPHEN W. DEAN, D.M.D.
Entity Type:Organization
Organization Name:STEPHEN W. DEAN, D.M.D.
Other - Org Name:COVINGTON COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-786-3915
Mailing Address - Street 1:PO BOX 1826
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30015-1826
Mailing Address - Country:US
Mailing Address - Phone:770-786-3915
Mailing Address - Fax:770-786-7863
Practice Address - Street 1:4106 MILL ST NE
Practice Address - Street 2:SUITE B
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2539
Practice Address - Country:US
Practice Address - Phone:770-786-3915
Practice Address - Fax:770-786-7863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA108861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty