Provider Demographics
NPI:1972636835
Name:SANTA BARBARA NEIGHBORHOOD CLINICS
Entity Type:Organization
Organization Name:SANTA BARBARA NEIGHBORHOOD CLINICS
Other - Org Name:EASTSIDE FAMILY DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL SERVICES DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:KEARNEHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-968-1511
Mailing Address - Street 1:923 N MILPAS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2331
Mailing Address - Country:US
Mailing Address - Phone:805-884-1998
Mailing Address - Fax:805-884-1875
Practice Address - Street 1:923 N MILPAS ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2331
Practice Address - Country:US
Practice Address - Phone:805-884-1998
Practice Address - Fax:805-884-1875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG92862-01Medicaid