Provider Demographics
NPI:1871529040
Name:ALCORN, DEAN (RDH BS)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:
Last Name:ALCORN
Suffix:
Gender:M
Credentials:RDH BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 INDUSTRIAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:MI
Mailing Address - Zip Code:49013
Mailing Address - Country:US
Mailing Address - Phone:269-427-7937
Mailing Address - Fax:269-427-5180
Practice Address - Street 1:5498 109TH AVENUE
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:MI
Practice Address - Zip Code:49450
Practice Address - Country:US
Practice Address - Phone:269-236-5021
Practice Address - Fax:269-236-5411
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902007396124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist