Provider Demographics
NPI:1780607655
Name:DEAN, SHANA D (DMD)
Entity type:Individual
Prefix:MS
First Name:SHANA
Middle Name:D
Last Name:DEAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3977 SEVENTH STREET RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216
Mailing Address - Country:US
Mailing Address - Phone:502-449-1961
Mailing Address - Fax:502-449-9866
Practice Address - Street 1:3977 SEVENTH STREET RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-449-1961
Practice Address - Fax:502-449-9866
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7736122300000X
TX0023683122300000X
TX23683122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist