Provider Demographics
NPI:1669725339
Name:DEAN DENTAL PLLC
Entity type:Organization
Organization Name:DEAN DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:724-222-2256
Mailing Address - Street 1:125 N FRANKLIN DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-5892
Mailing Address - Country:US
Mailing Address - Phone:724-222-2256
Mailing Address - Fax:724-222-9384
Practice Address - Street 1:125 N FRANKLIN DR
Practice Address - Street 2:SUITE 5
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-5892
Practice Address - Country:US
Practice Address - Phone:724-222-2256
Practice Address - Fax:724-222-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037786122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty