Provider Demographics
NPI:1255538781
Name:DEAN, TERESA (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 WILSHIRE BLVD # 300
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5720
Mailing Address - Country:US
Mailing Address - Phone:310-695-2450
Mailing Address - Fax:
Practice Address - Street 1:2121 WILSHIRE BLVD # 300
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5720
Practice Address - Country:US
Practice Address - Phone:310-695-2450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I118436Medicare UPIN