Provider Demographics
NPI:1679781603
Name:DEAN, AFSANEH KHORSANDIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:AFSANEH
Middle Name:KHORSANDIAN
Last Name:DEAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15616 BEREA DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3005
Mailing Address - Country:US
Mailing Address - Phone:561-261-3390
Mailing Address - Fax:727-938-2867
Practice Address - Street 1:4916 MILE STRETCH DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-4333
Practice Address - Country:US
Practice Address - Phone:727-938-2866
Practice Address - Fax:727-938-2867
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16150122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist