Provider Demographics
NPI:1952495715
Name:MOURSELAS, DEAN JASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:JASON
Last Name:MOURSELAS
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 1:501 GOODLETTE RD N
Mailing Address - Street 2:STE B202
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5473
Mailing Address - Country:US
Mailing Address - Phone:239-530-4000
Mailing Address - Fax:
Practice Address - Street 1:201 8TH ST S
Practice Address - Street 2:SUITE 106
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-6107
Practice Address - Country:US
Practice Address - Phone:239-261-7291
Practice Address - Fax:239-261-7291
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist