Healthcare Provider Details

I. General information

NPI: 1023191038
Provider Name (Legal Business Name): DEAN M DELUKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST
RICHMOND VA
23298-5064
US

IV. Provider business mailing address

521 N 11TH ST RM 311
RICHMOND VA
23298-5016
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-6637
  • Fax: 804-827-1040
Mailing address:
  • Phone: 518-441-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0401413275
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number0438000293
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number0401413275
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: