Healthcare Provider Details

I. General information

NPI: 1003764572
Provider Name (Legal Business Name): CHANNEL ISLANDS OMS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 BATH ST
SANTA BARBARA CA
93105-4324
US

IV. Provider business mailing address

2425 BATH ST
SANTA BARBARA CA
93105-4324
US

V. Phone/Fax

Practice location:
  • Phone: 805-682-0933
  • Fax:
Mailing address:
  • Phone: 805-682-0933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: JESSE LANZON
Title or Position: PARTNER
Credential: DDS, MD
Phone: 510-388-3233