Provider Demographics
NPI:1124182837
Name:SANTOS, AUGUSTO ADRIANO (DDS)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:ADRIANO
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 1:9538 SUNGLOW CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5764
Mailing Address - Country:US
Mailing Address - Phone:909-980-9187
Mailing Address - Fax:909-980-9187
Practice Address - Street 1:10144 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6725
Practice Address - Country:US
Practice Address - Phone:909-428-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53864122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist