Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 36982 | CA |
NPI | 1053323949 |
---|---|
Provider Name | Dr. Roy Evan Mintzer |
First Address | Santa Barbara, CA 93105-5518 |
Second Address | Santa Barbara, CA 93105-5518 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/07/2007 |