Provider Demographics
NPI:1053323949
Name:MINTZER, ROY EVAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:EVAN
Last Name:MINTZER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 STATE ST
Mailing Address - Street 2:#3
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5518
Mailing Address - Country:US
Mailing Address - Phone:805-682-5600
Mailing Address - Fax:805-682-5112
Practice Address - Street 1:2780 STATE ST
Practice Address - Street 2:#3
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5518
Practice Address - Country:US
Practice Address - Phone:805-682-5600
Practice Address - Fax:805-682-5112
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA369821223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics