Provider Demographics
NPI:1972634483
Name:DEAN, ROBERT L (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:DEAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 BUR OAK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-4352
Mailing Address - Country:US
Mailing Address - Phone:937-548-5051
Mailing Address - Fax:937-548-8443
Practice Address - Street 1:444 BUR OAK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-4352
Practice Address - Country:US
Practice Address - Phone:937-548-5051
Practice Address - Fax:937-548-8443
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0162801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice