Provider Demographics
NPI:1003673815
Name:DEAN PRINCE MD INC
Entity type:Organization
Organization Name:DEAN PRINCE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-987-7873
Mailing Address - Street 1:14501 CALVERT ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-2806
Mailing Address - Country:US
Mailing Address - Phone:310-987-7873
Mailing Address - Fax:
Practice Address - Street 1:14501 CALVERT ST STE 200
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-2806
Practice Address - Country:US
Practice Address - Phone:310-987-7873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty