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General NPI Number Information
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NPI Number | 1790078509
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Entity Type | Individual
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Provider Name | JENNIFER DEAN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/26/2011
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 5531 CANCHA DE GOLF SUITE 102
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City | RANCHO SANTA FE
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State | CA
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Zip | 92091-4042
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Country | US
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Telephone | 858-367-3058
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Fax |
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Provider Business Mailing Address
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Address Line | 5531 CANCHA DE GOLF SUITE 102
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City | RANCHO SANTA FE
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State | CA
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Zip | 92091-4042
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Country | US
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Telephone | 858-367-3058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 61367
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License Number State | CA
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