Healthcare Provider Details

I. General information

NPI: 1952300345
Provider Name (Legal Business Name): THOMAS M DEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 1ST ST NE
WESSINGTON SPRINGS SD
57382-2134
US

IV. Provider business mailing address

602 1ST ST NE
WESSINGTON SPRINGS SD
57382-2134
US

V. Phone/Fax

Practice location:
  • Phone: 605-539-1778
  • Fax: 605-539-9546
Mailing address:
  • Phone: 605-539-1778
  • Fax: 605-539-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2309
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: