Provider Demographics
NPI:1386701225
Name:SANTOS, ANTHONY KIP (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:KIP
Last Name:SANTOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14529 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2003
Mailing Address - Country:US
Mailing Address - Phone:408-356-6033
Mailing Address - Fax:408-356-0562
Practice Address - Street 1:14529 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2003
Practice Address - Country:US
Practice Address - Phone:408-356-6033
Practice Address - Fax:408-356-0562
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice