Provider Demographics
NPI:1215270830
Name:SANTOS DENTAL PA.
Entity type:Organization
Organization Name:SANTOS DENTAL PA.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-474-0400
Mailing Address - Street 1:18652 NW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2406
Mailing Address - Country:US
Mailing Address - Phone:305-474-0400
Mailing Address - Fax:305-474-0094
Practice Address - Street 1:18652 NW 67TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2406
Practice Address - Country:US
Practice Address - Phone:305-474-0400
Practice Address - Fax:305-474-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18334122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty