Provider Demographics
NPI:1982849477
Name:DEER, EDWIN W (DDS)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:W
Last Name:DEER
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 1:11 GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2661
Mailing Address - Country:US
Mailing Address - Phone:415-453-7501
Mailing Address - Fax:415-453-7506
Practice Address - Street 1:11 GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2661
Practice Address - Country:US
Practice Address - Phone:415-453-7501
Practice Address - Fax:415-453-7506
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22486122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist