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General NPI Number Information
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NPI Number | 1700046968
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Entity Type | Individual
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Provider Name | GRETCHEN R DEAN DO
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Gender | Female
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 11/28/2011
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Provider Practice Location Address
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Address Line | 10101 S 27TH ST
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City | FRANKLIN
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State | WI
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Zip | 53132-7209
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Country | US
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Telephone | 414-817-5800
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Fax |
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Provider Business Mailing Address
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Address Line | 210 N TUSTIN AVE
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City | SANTA ANA
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State | CA
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Zip | 92705-3807
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Country | US
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Telephone | 714-347-1010
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Fax | 714-647-1245
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 51695-21
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License Number State | WI
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