Provider Demographics
NPI:1477124212
Name:MANN, JOSEPH JACKSON (DDS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JACKSON
Last Name:MANN
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 1:438 VENADO DR
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-1546
Mailing Address - Country:US
Mailing Address - Phone:805-680-2173
Mailing Address - Fax:
Practice Address - Street 1:1819 STATE ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2481
Practice Address - Country:US
Practice Address - Phone:805-569-0716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1064351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice