Healthcare Provider Details

I. General information

NPI: 1699861302
Provider Name (Legal Business Name): SANTA YNEZ TRIBAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 VIA JUANA RD
SANTA YNEZ CA
93460-9679
US

IV. Provider business mailing address

892 ALAMO PINTADO RD
SOLVANG CA
93463-9788
US

V. Phone/Fax

Practice location:
  • Phone: 805-688-7070
  • Fax:
Mailing address:
  • Phone: 805-693-1658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number48061
License Number StateCA

VIII. Authorized Official

Name: DR. GUY MARKHAM
Title or Position: DENTAL DIRECTOR
Credential: DDS
Phone: 805-688-7070