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General NPI Number Information
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NPI Number | 1376230805
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Entity Type | Organization
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Legal Business Name | TRAHAN PEDIATRIC DENTAL GROUP
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Dates
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Enumeration Date | 04/24/2023
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 122 S PATTERSON AVE # C-133
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City | SANTA BARBARA
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State | CA
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Zip | 93111-2055
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Country | US
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Telephone | 805-456-2866
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Fax |
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Provider Business Mailing Address
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Address Line | 122 S PATTERSON AVE # C-133
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City | SANTA BARBARA
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State | CA
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Zip | 93111-2055
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Country | US
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Telephone | 805-456-2866
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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. STEPHANIE LISE TRAHAN
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Credential | DMD, MPH, MA
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Telephone | 805-403-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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