Individual
CEDRIC DEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPP
Contact information
Practice address
2001 CATHERINE SIMMONS AVE, CHARLOTTE, NC 28216-4677
(704) 492-1533
Mailing address
5502 MCCHESNEY DR, CHARLOTTE, NC 28269-7188
(704) 492-5509
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
2021877201
NC
251K00000X
Public Health or Welfare Agency
2021877201
NC
305R00000X
Preferred Provider Organization
2021877201
NC
405300000X
Prevention Professional
Primary
2021877201
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000005049292
DMV
NC
01
—
1497473086
PRIVATE INSURANCE
NC
05
—
832424267
—
NC
Enumeration date
08/31/2022
Last updated
06/24/2024
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