Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 09007 | IA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D1013 | SD |
NPI | 1073687711 |
---|---|
Provider Name | Jeffrey S Dean |
First Address | Dakota Dunes, SD 57049-5095 |
Second Address | Dakota Dunes, SD 57049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 09/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1548304710 | (05) | IA |
1548304710 | (05) | SD |
1548304710 | BC/BS OF IA (01) | IA |
1548304710 | BC/BS OF SD (01) | SD |
91201365400 | (05) | NE |
G49612 | (02) | ID |