Healthcare Provider Details

I. General information

NPI: 1225432388
Provider Name (Legal Business Name): JOHN DEAN DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 CRESTWOOD RD STE 2
NORTH LITTLE ROCK AR
72116-7648
US

IV. Provider business mailing address

2524 CRESTWOOD RD STE 2
NORTH LITTLE ROCK AR
72116-7648
US

V. Phone/Fax

Practice location:
  • Phone: 501-771-2911
  • Fax: 501-758-2078
Mailing address:
  • Phone: 501-771-2911
  • Fax: 501-758-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number3118
License Number StateAR

VIII. Authorized Official

Name: DR. JOHN HAMILTON DEAN
Title or Position: DENTIST
Credential: DDS
Phone: 501-771-2911