Provider Demographics
NPI:1104890441
Name:DEAN, JEFFREY K (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:K
Last Name:DEAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 W HOWARD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1321
Mailing Address - Country:US
Mailing Address - Phone:414-321-6486
Mailing Address - Fax:414-321-5174
Practice Address - Street 1:10700 W HOWARD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1321
Practice Address - Country:US
Practice Address - Phone:414-321-6486
Practice Address - Fax:414-321-5174
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23340151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice