Provider Demographics
NPI:1730959909
Name:DEAN, DAVID R JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:DEAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 2ND STREET
Mailing Address - Street 2:
Mailing Address - City:PORT WILLIAM
Mailing Address - State:OH
Mailing Address - Zip Code:45164
Mailing Address - Country:US
Mailing Address - Phone:937-527-4243
Mailing Address - Fax:
Practice Address - Street 1:226 2ND STREET
Practice Address - Street 2:
Practice Address - City:PORT WILLIAM
Practice Address - State:OH
Practice Address - Zip Code:45164
Practice Address - Country:US
Practice Address - Phone:937-527-4243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251X00000XAgenciesSupports Brokerage
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No376J00000XNursing Service Related ProvidersHomemaker