=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972889897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERIK S. WIPF, DDS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2011
-----------------------------------------------------
Last Update Date | 10/24/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1819 STATE ST STE C
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93101-2481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-569-0716
-----------------------------------------------------
Fax | 805-569-1626
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1819 STATE ST STE C
-----------------------------------------------------
City | SANTA BARBARA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93101-2481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-569-0716
-----------------------------------------------------
Fax | 805-569-1626
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ERIK S WIPF
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 805-569-0716
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 44124
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------