MEDICARE: DR. JOHN ERIC 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	5124408-9922	UT

General Provider Information

NPI Number	:	1518015213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN ERIC DEAN DDS

Provider Business Mailing Address
First Line	:	9897 BIRDIE WAY
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84095-9777
Country	:	US
Telephone Number	:	801-280-4161
Fax Number	:

Provider Business Practice Location Address
First Line	:	1951 W 4700 S
Second Line	:	STE 5
City	:	TAYLORSVILLE
State	:	UT
Zip	:	84118-1108
Country	:	US
Telephone Number	:	801-969-1800
Fax Number	:

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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