Basic Information
| Provider Information | |||||||||
| NPI: | 1710034970 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEXTER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5142 HOLLISTER AVE # 113 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931112526 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056967923 | ||||||||
| FaxNumber: | 8056367921 | ||||||||
| Practice Location | |||||||||
| Address1: | 2705 LOMA VISTA RD STE 205 | ||||||||
| Address2: | |||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930031582 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055853086 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G38860 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.