Provider Demographics
NPI:1346529880
Name:PLICKA, JEFFERSON CHAD (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFERSON
Middle Name:CHAD
Last Name:PLICKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 TIBER AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2963
Mailing Address - Country:US
Mailing Address - Phone:801-367-4214
Mailing Address - Fax:
Practice Address - Street 1:200 N LA CUMBRE RD
Practice Address - Street 2:SUITE #H
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1577
Practice Address - Country:US
Practice Address - Phone:805-687-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist