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General NPI Number Information
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NPI Number | 1215232079
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Entity Type | Organization
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Legal Business Name | WIPF AND FICSOR DENTAL CORPORATION
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Dates
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Enumeration Date | 01/25/2011
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Last Update Date | 04/17/2011
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Provider Practice Location Address
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Address Line | 1819 STATE ST SUITE D
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City | SANTA BARBARA
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State | CA
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Zip | 93101-2449
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Country | US
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Telephone | 805-569-0716
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Fax |
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Provider Business Mailing Address
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Address Line | 1819 STATE ST SUITE D
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City | SANTA BARBARA
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State | CA
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Zip | 93101-2449
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Country | US
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Telephone | 805-569-0716
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ERIK S WIPF
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Credential | DDS
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Telephone | 805-569-0716
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 44124
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License Number State | CA
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