Provider Demographics
NPI:1114446853
Name:SANT, TAYLOR JON (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:JON
Last Name:SANT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CLOVER
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4556
Mailing Address - Country:US
Mailing Address - Phone:678-471-6897
Mailing Address - Fax:
Practice Address - Street 1:6990 EL CAMINO REAL STE O
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4112
Practice Address - Country:US
Practice Address - Phone:760-438-0175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist