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Individual

DR. DEAN A SMITH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
13060 ISLE DR, BAXTER, MN 56425-8331
(218) 828-2880
Mailing address
523 N 3RD ST, BRAINERD, MN 56401-3054
(218) 829-2861
(218) 828-3103

Taxonomy

Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
51280
MN
2080A0000X
Pediatric Adolescent Medicine Physician
6930A
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1188372-00
WY
01
312449
BLUE CROSS BLUE SHIELD
WY
Enumeration date
06/06/2006
Last updated
01/15/2016
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