Healthcare Provider Details

I. General information

NPI: 1861469306
Provider Name (Legal Business Name): GUY C MARKHAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VIA JUANA LANE
SANTA YNEZ CA
93460-9405
US

IV. Provider business mailing address

922 VISTA DEL RIO
SANTA MARIA CA
93458
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-7070
  • Fax: 805-686-2060
Mailing address:
  • Phone: 805-614-9596
  • Fax: 805-614-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: