Provider Demographics
NPI:1952899973
Name:DEAN, MARK ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
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:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:BLANCO
Mailing Address - State:TX
Mailing Address - Zip Code:78606-0129
Mailing Address - Country:US
Mailing Address - Phone:830-833-5367
Mailing Address - Fax:
Practice Address - Street 1:517 1ST ST
Practice Address - Street 2:
Practice Address - City:BLANCO
Practice Address - State:TX
Practice Address - Zip Code:78606-5537
Practice Address - Country:US
Practice Address - Phone:830-833-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN108111223G0001X
TX398281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty