Healthcare Provider Details

I. General information

NPI: 1275701419
Provider Name (Legal Business Name): DEAN PLASTIC SURGERY ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 07/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4832 LINCOLN BLVD
MARINA DEL REY CA
90292-6917
US

IV. Provider business mailing address

2200 N MAYFAIR RD SUITE 200
WAUWATOSA WI
53226-2252
US

V. Phone/Fax

Practice location:
  • Phone: 310-860-0646
  • Fax: 310-496-0252
Mailing address:
  • Phone: 414-258-9511
  • Fax: 414-607-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA96010
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAY BYRON DEAN
Title or Position: OWNER
Credential: MD
Phone: 310-860-0646