Provider Demographics
NPI:1306991930
Name:SMITH, DEAN WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:WALTER
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2755 LOMA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1544
Mailing Address - Country:US
Mailing Address - Phone:805-477-9922
Mailing Address - Fax:805-477-9937
Practice Address - Street 1:2755 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1544
Practice Address - Country:US
Practice Address - Phone:805-477-9922
Practice Address - Fax:805-477-9937
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71909207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH26875Medicare UPIN
CAW18226Medicare ID - Type Unspecified