Provider Demographics
NPI:1033567441
Name:MAURICIO DOSSANTOS DDS
Entity Type:Organization
Organization Name:MAURICIO DOSSANTOS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DOSSANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-709-6766
Mailing Address - Street 1:12033 4TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2755
Mailing Address - Country:US
Mailing Address - Phone:909-790-1951
Mailing Address - Fax:909-790-1561
Practice Address - Street 1:12033 4TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2755
Practice Address - Country:US
Practice Address - Phone:909-790-1951
Practice Address - Fax:909-790-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA617111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty