MEDICARE: DR. CLARENCE DEAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12007193	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174605901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLARENCE DEAN DDS

Provider Business Mailing Address
First Line	:	222 INNISBROOKE AVE
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-9209
Country	:	US
Telephone Number	:	317-889-1578
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 INNISBROOKE AVE
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46142-9209
Country	:	US
Telephone Number	:	317-889-1578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	05/06/2009

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