MEDICARE: SANTA BARBARA DENTAL SPA

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	1223G0001X	General Practice Dentistry	35316	CA

General Provider Information

NPI Number	:	1063533081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTA BARBARA DENTAL SPA

Provider Business Mailing Address
First Line	:	1933 CLIFF DR STE 8
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93109-1520
Country	:	US
Telephone Number	:	805-560-9999
Fax Number	:	805-456-3344

Provider Business Practice Location Address
First Line	:	1933 CLIFF DR STE 8
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93109-1520
Country	:	US
Telephone Number	:	805-560-9999
Fax Number	:	805-456-3344

Authorized Official
Title or Position	:	OWNER
Name	:	B K RAI
Credential	:	DDS
Telephone Number	:	805-560-9999

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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1447383708 — DR. B K RAI DDS
Practice Location Address:

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