Provider Demographics
NPI:1093133894
Name:DEAN, ETHAN WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:WESLEY
Last Name:DEAN
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 1:620 CHEROKEE ST NE STE 300
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7233
Mailing Address - Country:US
Mailing Address - Phone:770-635-1812
Mailing Address - Fax:770-485-2883
Practice Address - Street 1:620 CHEROKEE ST NE STE 300
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7233
Practice Address - Country:US
Practice Address - Phone:770-635-1812
Practice Address - Fax:770-485-2883
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89800207X00000X
FLME146177207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery