Provider Demographics
NPI:1174611651
Name:DEAN, ANTHONY T (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:T
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 1:7458 FLEMING ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-9338
Mailing Address - Country:US
Mailing Address - Phone:904-284-3766
Mailing Address - Fax:
Practice Address - Street 1:945 LANE AVE S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-4706
Practice Address - Country:US
Practice Address - Phone:904-781-4011
Practice Address - Fax:904-781-1726
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 114351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL67912OtherBCBS/FLCOMBLIFE PROVIDER
FL085024OtherUNITED CONCORDIA PROVIDER