Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 0401413275 | VA |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 0401413275 | VA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 0438000293 | VA |
NPI | 1023191038 |
---|---|
Provider Name | Dr. Dean M Deluke |
First Address | Schenectady, NY 12308-2410 |
Second Address | Richmond, VA 23298-5064 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 23/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00711564 | (05) | NY |
190009682 | RAILROAD MEDICARE (01) | NY |
U13024 | (02) | NY |