MEDICARE: DR. JAMES G STATHIS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	33668	CA

General Provider Information

NPI Number	:	1902077894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES G STATHIS D.D.S.

Provider Business Mailing Address
First Line	:	3905 STATE ST
Second Line	:	264
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3138
Country	:	US
Telephone Number	:	805-451-0118
Fax Number	:	805-563-9741

Provider Business Practice Location Address
First Line	:	3905 STATE ST
Second Line	:	264
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-3138
Country	:	US
Telephone Number	:	805-451-0118
Fax Number	:	805-563-9741

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/25/2010

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