MEDICARE: STEPHEN 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	1223G0001X	General Practice Dentistry	10886	GA

General Provider Information

NPI Number	:	1790103141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN W. DEAN, D.M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1826
Second Line	:
City	:	COVINGTON
State	:	GA
Zip	:	30015-1826
Country	:	US
Telephone Number	:	770-786-3915
Fax Number	:	770-786-7863

Provider Business Practice Location Address
First Line	:	4106 MILL ST NE
Second Line	:	SUITE B
City	:	COVINGTON
State	:	GA
Zip	:	30014-2539
Country	:	US
Telephone Number	:	770-786-3915
Fax Number	:	770-786-7863

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. STEPHEN WESLEY DEAN
Credential	:	D.M.D.
Telephone Number	:	770-786-3915

Provider Enumeration Date	:	04/02/2014
Last Update Date	:	04/02/2014

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