MEDICARE: CHANNEL ISLANDS OMS GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)

General Provider Information

NPI Number	:	1003764572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANNEL ISLANDS OMS GROUP

Provider Business Mailing Address
First Line	:	2425 BATH ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4324
Country	:	US
Telephone Number	:	805-682-0933
Fax Number	:

Provider Business Practice Location Address
First Line	:	2425 BATH ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-4324
Country	:	US
Telephone Number	:	805-682-0933
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	JESSE LANZON
Credential	:	DDS, MD
Telephone Number	:	510-388-3233

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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