Provider Demographics
NPI:1184643702
Name:SANTOS, MARIA V (DMD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:V
Last Name:SANTOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 W ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4735
Mailing Address - Country:US
Mailing Address - Phone:714-871-8093
Mailing Address - Fax:714-871-8133
Practice Address - Street 1:1103 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4735
Practice Address - Country:US
Practice Address - Phone:714-871-8093
Practice Address - Fax:714-871-8133
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39078122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA977480OtherUNITED CONCORDIA
CAB3907801OtherDENTI-CAL