Individual provider Active NPI

Jefferson Chad Plicka, DMD

  • Dentist
  • Santa Barbara, CA
National Provider Identifier
1346529880
Registry record updated Aug 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
60446 Issued in CA
Practice address
200 N la Cumbre Rd
Suite #H
Santa Barbara, CA 93110-1577
Phone
(805) 687-6767
NPI assigned
Aug 16, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 60446 CA Primary

Addresses

Primary practice location

200 N la Cumbre Rd
Suite #H
Santa Barbara, CA 93110-1577

Mailing address

2713 Tiber Ave
Davis, CA 95616-2963
Phone (801) 367-4214

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
60446CAMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313452800000",
    "number": "1346529880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2713 TIBER AVE",
            "city": "DAVIS",
            "state": "CA",
            "postal_code": "956162963",
            "telephone_number": "801-367-4214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N LA CUMBRE RD",
            "address_2": "SUITE #H",
            "city": "SANTA BARBARA",
            "state": "CA",
            "postal_code": "931101577",
            "telephone_number": "805-687-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLICKA",
        "first_name": "JEFFERSON",
        "middle_name": "CHAD",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-16",
        "last_updated": "2011-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "60446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Barbara, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.