Provider Demographics
NPI:1356495360
Name:PHREANER, JOHN HALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HALL
Last Name:PHREANER
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 1:1515 STATE ST
Mailing Address - Street 2:SUITE 18
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2536
Mailing Address - Country:US
Mailing Address - Phone:805-963-5934
Mailing Address - Fax:805-966-9808
Practice Address - Street 1:1515 STATE ST
Practice Address - Street 2:SUITE 18
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2536
Practice Address - Country:US
Practice Address - Phone:805-963-5934
Practice Address - Fax:805-966-9808
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice