Provider Demographics
NPI:1184618845
Name:DEAS, DAVID EDGAR (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDGAR
Last Name:DEAS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2036
Mailing Address - Country:US
Mailing Address - Phone:830-816-5102
Mailing Address - Fax:
Practice Address - Street 1:248 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2036
Practice Address - Country:US
Practice Address - Phone:830-816-5102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0096291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics