Provider Demographics
NPI:1881979425
Name:TRAHAN, STEPHANIE LISE (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:LISE
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 S PATTERSON AVE # C-133
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2055
Mailing Address - Country:US
Mailing Address - Phone:805-403-6226
Mailing Address - Fax:
Practice Address - Street 1:122 S PATTERSON AVE # C-133
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93111-2055
Practice Address - Country:US
Practice Address - Phone:805-403-6226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.0079963122300000X
CADDS1062191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist