Provider Demographics
NPI:1053679258
Name:SANTOS, LOLITA GUEVARRA (DENTURIST)
Entity Type:Individual
Prefix:
First Name:LOLITA
Middle Name:GUEVARRA
Last Name:SANTOS
Suffix:
Gender:F
Credentials:DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9735 S 222ND ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-2410
Mailing Address - Country:US
Mailing Address - Phone:206-661-0520
Mailing Address - Fax:
Practice Address - Street 1:9735 S 222ND ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-2410
Practice Address - Country:US
Practice Address - Phone:206-661-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN 60270518122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist