Provider Demographics
NPI:1205304540
Name:JOHN A. DEAKINS DDS PC
Entity type:Organization
Organization Name:JOHN A. DEAKINS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEAKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-781-7280
Mailing Address - Street 1:6 VICTORY LN
Mailing Address - Street 2:STE 1
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2053
Mailing Address - Country:US
Mailing Address - Phone:816-781-7280
Mailing Address - Fax:816-781-7568
Practice Address - Street 1:6 VICTORY LN
Practice Address - Street 2:STE 1
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2053
Practice Address - Country:US
Practice Address - Phone:816-781-7280
Practice Address - Fax:816-781-7568
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN A. DEAKINS DDS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty