Healthcare Provider Details

I. General information

NPI: 1801998901
Provider Name (Legal Business Name): JON P DEAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CASS STREET SUITE 100
MONTEREY CA
93940
US

IV. Provider business mailing address

920 CASS STREET SUITE 100
MONTEREY CA
93940
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-1377
  • Fax: 831-372-0463
Mailing address:
  • Phone: 831-373-1377
  • Fax: 831-372-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number42537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: