Organization
DEAN FAMILY DENTAL PRACTICE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNE E. DEAN (MEMBER, LLC / OFFICE MANAGER)
(812) 425-4251
Entity
Organization
Contact information
Practice address
710 W MILL RD, EVANSVILLE, IN 47710-3928
(812) 425-4251
(812) 425-3086
Mailing address
710 W MILL RD, EVANSVILLE, IN 47710-3928
(812) 425-4251
(812) 425-3086
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12006932A
IN
1223G0001X
General Practice Dentistry
12011866A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100241450A
—
IN
Enumeration date
06/03/2013
Last updated
06/03/2013
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