MEDICARE: MELVIN W. DEAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	KY 4744	KY

General Provider Information

NPI Number	:	1164539979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELVIN W. DEAN D.M.D.

Provider Business Mailing Address
First Line	:	1517 NICHOLASVILLE RD
Second Line	:	SUITE 201
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1429
Country	:	US
Telephone Number	:	859-276-2546
Fax Number	:	859-278-8846

Provider Business Practice Location Address
First Line	:	1517 NICHOLASVILLE RD
Second Line	:	SUITE 201
City	:	LEXINGTON
State	:	KY
Zip	:	40503-1429
Country	:	US
Telephone Number	:	859-276-2546
Fax Number	:	859-278-8846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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