Provider Demographics
NPI:1689567828
Name:DEAN, THEODORE JAMES (PA STUDENT)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:JAMES
Last Name:DEAN
Suffix:
Gender:M
Credentials:PA STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 GOLDEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-3201
Mailing Address - Country:US
Mailing Address - Phone:952-807-7262
Mailing Address - Fax:
Practice Address - Street 1:6612 GOLDEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-3201
Practice Address - Country:US
Practice Address - Phone:952-807-7262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-29
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program