Provider Demographics
NPI:1780698175
Name:DEAN, DAVID (DMD PC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DEAN
Suffix:
Gender:M
Credentials:DMD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-2917
Mailing Address - Country:US
Mailing Address - Phone:617-361-5020
Mailing Address - Fax:617-361-3463
Practice Address - Street 1:1138 RIVER STREET
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-2917
Practice Address - Country:US
Practice Address - Phone:617-361-5020
Practice Address - Fax:617-361-3463
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA141951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice