Provider Demographics
NPI:1316328453
Name:SANTIBANEZ, VICTORIA (DDS)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:SANTIBANEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22207 MERRYMOUNT DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-2419
Mailing Address - Country:US
Mailing Address - Phone:214-808-4726
Mailing Address - Fax:
Practice Address - Street 1:5102 FM 1463 RD STE 100
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-7871
Practice Address - Country:US
Practice Address - Phone:281-204-2156
Practice Address - Fax:281-547-7340
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist