Provider Demographics
NPI:1669672838
Name:WILLIAM J BLYTHE DDS INC
Entity Type:Organization
Organization Name:WILLIAM J BLYTHE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:BLYTHE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-687-5600
Mailing Address - Street 1:2780 STATE ST STE 6
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5522
Mailing Address - Country:US
Mailing Address - Phone:805-687-5600
Mailing Address - Fax:
Practice Address - Street 1:2780 STATE ST STE 6
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-5522
Practice Address - Country:US
Practice Address - Phone:805-687-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA164701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty