MEDICARE: DR. ANTHONY T DEAN DDS

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	1223G0001X	General Practice Dentistry	DN 11435	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	67912	OTHER	FL	BCBS/FLCOMBLIFE PROVIDER
2	085024	OTHER	FL	UNITED CONCORDIA PROVIDER

General Provider Information

NPI Number	:	1174611651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY T DEAN DDS

Provider Business Mailing Address
First Line	:	7458 FLEMING ISLAND DR
Second Line	:
City	:	GREEN COVE SPRINGS
State	:	FL
Zip	:	32043-9338
Country	:	US
Telephone Number	:	904-284-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	945 LANE AVE S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-4706
Country	:	US
Telephone Number	:	904-781-4011
Fax Number	:	904-781-1726

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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