Provider Demographics
NPI:1467198283
Name:PATHWAY DENTAL GROUP SANTA MARIA
Entity Type:Organization
Organization Name:PATHWAY DENTAL GROUP SANTA MARIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-708-7866
Mailing Address - Street 1:1919 STATE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-0406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:426 BARCELLUS AVE STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6927
Practice Address - Country:US
Practice Address - Phone:805-928-7833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental