Provider Demographics
NPI:1801969696
Name:DEAN, CHARLES H (DDS)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:DEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BOBWHITE DR
Mailing Address - Street 2:
Mailing Address - City:ENON
Mailing Address - State:OH
Mailing Address - Zip Code:45323-9716
Mailing Address - Country:US
Mailing Address - Phone:937-864-2146
Mailing Address - Fax:
Practice Address - Street 1:2458 DAYTON XENIA RD
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45434-7168
Practice Address - Country:US
Practice Address - Phone:937-429-3160
Practice Address - Fax:937-429-2174
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-74491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice