Healthcare Provider Details

I. General information

NPI: 1073687711
Provider Name (Legal Business Name): JEFFREY S DEAN D.D.S., M.D., FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 OAK TREE LN
DAKOTA DUNES SD
57049
US

IV. Provider business mailing address

301 OAK TREE LN
DAKOTA DUNES SD
57049-5095
US

V. Phone/Fax

Practice location:
  • Phone: 605-242-0107
  • Fax: 605-242-0145
Mailing address:
  • Phone: 605-242-0107
  • Fax: 605-242-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number09007
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD1013
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: