Provider Demographics
NPI:1700968914
Name:DEAN, RON G (DMD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:G
Last Name:DEAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 BUR OAK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-4352
Mailing Address - Country:US
Mailing Address - Phone:937-548-5051
Mailing Address - Fax:937-548-8443
Practice Address - Street 1:444 BUR OAK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-4352
Practice Address - Country:US
Practice Address - Phone:937-548-5051
Practice Address - Fax:937-548-8443
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021271122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2636768Medicaid