Provider Demographics
NPI:1184833659
Name:SANTOS, LIVIA IRIS
Entity Type:Individual
Prefix:DR
First Name:LIVIA
Middle Name:IRIS
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 CAMINO MIRAMELINDA
Mailing Address - Street 2:SABANERA
Mailing Address - City:CIDRA
Mailing Address - State:PR
Mailing Address - Zip Code:00739
Mailing Address - Country:US
Mailing Address - Phone:787-714-0681
Mailing Address - Fax:
Practice Address - Street 1:B CIDRA PROFESSIONAL CENTER
Practice Address - Street 2:LOCAL 3
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00739
Practice Address - Country:US
Practice Address - Phone:787-714-0681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist