MEDICARE: JENNIFER DEAN D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	64414	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1710392881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DEAN D.D.S.

Provider Business Mailing Address
First Line	:	1140 MALCOLM DIXON RD
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-3808
Country	:	US
Telephone Number	:	951-203-6201
Fax Number	:

Provider Business Practice Location Address
First Line	:	4939 HILLSDALE CIR
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-5737
Country	:	US
Telephone Number	:	951-203-6201
Fax Number	:

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

Provider Enumeration Date	:	06/26/2014
Last Update Date	:	03/03/2026

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