Provider Demographics
NPI:1386788354
Name:SANTOS, NESTOR G (DDS)
Entity type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:G
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 1:11 MEDICAL PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3560
Mailing Address - Country:US
Mailing Address - Phone:845-354-1018
Mailing Address - Fax:845-354-4040
Practice Address - Street 1:11 MEDICAL PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3560
Practice Address - Country:US
Practice Address - Phone:845-354-1018
Practice Address - Fax:845-354-4040
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0463861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice