Healthcare Provider Details

I. General information

NPI: 1568534915
Provider Name (Legal Business Name): JOEL GLENN DEAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 E CHURCH ST STE 202
SANTA MARIA CA
93454-5915
US

IV. Provider business mailing address

1325 E CHURCH ST STE 202
SANTA MARIA CA
93454-5915
US

V. Phone/Fax

Practice location:
  • Phone: 805-346-3456
  • Fax: 805-346-3454
Mailing address:
  • Phone: 805-346-3456
  • Fax: 805-346-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD60465075
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD-13570
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberC195160
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: