Provider Demographics
NPI:1881022655
Name:DEAN, DAVID (RD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 RUSTIC ST
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-3434
Mailing Address - Country:US
Mailing Address - Phone:334-750-2622
Mailing Address - Fax:
Practice Address - Street 1:610 RUSTIC ST
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-3434
Practice Address - Country:US
Practice Address - Phone:334-750-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-14
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2229133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered