MEDICARE: ROBERT D DEAN DDS PS

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	261QD0000X	Dental Clinic/Center	DE00005408	WA

General Provider Information

NPI Number	:	1588967319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT D DEAN DDS PS

Provider Business Mailing Address
First Line	:	411 STRANDER BLVD STE 204
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2924
Country	:	US
Telephone Number	:	206-575-3326
Fax Number	:	206-575-3349

Provider Business Practice Location Address
First Line	:	411 STRANDER BLVD STE 204
Second Line	:
City	:	TUKWILA
State	:	WA
Zip	:	98188-2924
Country	:	US
Telephone Number	:	206-575-3326
Fax Number	:	206-575-3349

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT DANA DEAN
Credential	:	DDS
Telephone Number	:	206-575-3326

Provider Enumeration Date	:	12/16/2010
Last Update Date	:	12/16/2010

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