Healthcare Provider Details

I. General information

NPI: 1427382803
Provider Name (Legal Business Name): SHAWN L HLAVATY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 HOT SPRINGS RD
SANTA BARBARA CA
93108-2403
US

IV. Provider business mailing address

195 HOT SPRINGS RD
SANTA BARBARA CA
93108-2403
US

V. Phone/Fax

Practice location:
  • Phone: 805-455-2917
  • Fax:
Mailing address:
  • Phone: 805-455-2917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58895
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: