Healthcare Provider Details

I. General information

NPI: 1275560948
Provider Name (Legal Business Name): JEFFREY A DEAN DDS, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7830 ROCKVILLE RD
INDIANAPOLIS IN
46214-3129
US

IV. Provider business mailing address

5040 POTTERS PIKE
INDIANAPOLIS IN
46234-2943
US

V. Phone/Fax

Practice location:
  • Phone: 317-271-9727
  • Fax: 317-273-2373
Mailing address:
  • Phone: 317-292-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12008253B
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number12008253B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: