Provider Demographics
NPI:1588095780
Name:SANTA MONICA BAY DENTAL
Entity type:Organization
Organization Name:SANTA MONICA BAY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:FEIST
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-453-8606
Mailing Address - Street 1:2730 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4743
Mailing Address - Country:US
Mailing Address - Phone:310-453-8606
Mailing Address - Fax:310-453-7055
Practice Address - Street 1:2730 WILSHIRE BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4743
Practice Address - Country:US
Practice Address - Phone:310-453-8606
Practice Address - Fax:310-453-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56179122300000X
CA23635122300000X
CA53211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty