Healthcare Provider Details

I. General information

NPI: 1922023563
Provider Name (Legal Business Name): KEVIN C. DEAN D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4850 N 9TH AVE STE 4
PENSACOLA FL
32503-2406
US

IV. Provider business mailing address

4850 N 9TH AVE STE 4
PENSACOLA FL
32503-2406
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-1125
  • Fax: 850-479-5809
Mailing address:
  • Phone: 850-477-1125
  • Fax: 850-479-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN0012675
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4835
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: