Healthcare Provider Details

I. General information

NPI: 1255112413
Provider Name (Legal Business Name): DEAN W. SMITH, MD., A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 LOMA VISTA RD
VENTURA CA
93003-1544
US

IV. Provider business mailing address

2755 LOMA VISTA RD
VENTURA CA
93003-1544
US

V. Phone/Fax

Practice location:
  • Phone: 805-477-9922
  • Fax: 805-477-9937
Mailing address:
  • Phone: 805-477-9922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEANNA S BACON
Title or Position: MANAGER
Credential:
Phone: 805-477-9922