Provider Demographics
NPI:1194899179
Name:DEAN, DENNIS GERARD (CRNA)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:GERARD
Last Name:DEAN
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19363 WILLAMETTE DR
Mailing Address - Street 2:#191
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-2010
Mailing Address - Country:US
Mailing Address - Phone:971-404-5559
Mailing Address - Fax:503-699-8792
Practice Address - Street 1:19363 WILLAMETTE DR
Practice Address - Street 2:#191
Practice Address - City:WEST LINN
Practice Address - State:OR
Practice Address - Zip Code:97068-2010
Practice Address - Country:US
Practice Address - Phone:971-404-5559
Practice Address - Fax:503-699-8792
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered