Provider Demographics
NPI:1154040475
Name:SANTOS, LAURA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 NEPTUNE BAY CIR UNIT 1
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-7042
Mailing Address - Country:US
Mailing Address - Phone:201-898-7327
Mailing Address - Fax:
Practice Address - Street 1:528 NEPTUNE BAY CIR UNIT 1
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-7042
Practice Address - Country:US
Practice Address - Phone:201-898-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist