Provider Demographics
NPI:1497967541
Name:ANNIE PHAM-CHENG, DMD, INC
Entity Type:Organization
Organization Name:ANNIE PHAM-CHENG, DMD, INC
Other - Org Name:SANTA BARBARA CHILDREN'S DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAM-CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:805-681-7301
Mailing Address - Street 1:6134 CALLE REAL, STE B
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117
Mailing Address - Country:US
Mailing Address - Phone:805-681-7301
Mailing Address - Fax:805-681-7302
Practice Address - Street 1:6134 CALLE REAL, STE B
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117
Practice Address - Country:US
Practice Address - Phone:805-681-7301
Practice Address - Fax:805-681-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA533481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1891851408OtherTYPE 1 NPI NUMBER FOR DR.