Provider Demographics
NPI:1144636291
Name:GOLETA NEIGHBORHOOD DENTAL CLINIC
Entity type:Organization
Organization Name:GOLETA NEIGHBORHOOD DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:CAMILLO
Authorized Official - Last Name:FENZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-617-7850
Mailing Address - Street 1:915 N MILPAS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2331
Mailing Address - Country:US
Mailing Address - Phone:805-617-7850
Mailing Address - Fax:805-963-8880
Practice Address - Street 1:164 KINMAN AVE
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-3481
Practice Address - Country:US
Practice Address - Phone:805-617-7900
Practice Address - Fax:805-617-7899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANTA BARBARA NEIGHBORHOOD CLINICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-09
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental