# DEAN FAMILY DENTAL PRACTICE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629415419
- **Authorized official:** DIANNE E. DEAN (MEMBER, LLC / OFFICE MANAGER)
- **Authorized official phone:** (812) 425-4251

## Contact information

- **Practice address:** 710 W MILL RD, EVANSVILLE, IN 47710-3928
- **Practice address phone:** (812) 425-4251
- **Practice address fax:** (812) 425-3086
- **Mailing address:** 710 W MILL RD, EVANSVILLE, IN 47710-3928
- **Mailing address phone:** (812) 425-4251
- **Mailing address fax:** (812) 425-3086

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12006932A | IN | Yes |
| 1223G0001X | General Practice Dentistry | 12011866A | IN | — |

## Other

- **Enumeration date:** 06/03/2013
- **Last updated:** 06/03/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100241450A | — | IN |