Provider Demographics
NPI:1326458985
Name:SANTOS, PAUL RITCHARD BERNUS (DMD)
Entity Type:Individual
Prefix:
First Name:PAUL RITCHARD
Middle Name:BERNUS
Last Name:SANTOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:R
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:703 MILL CREEK RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3828
Mailing Address - Country:US
Mailing Address - Phone:609-978-8466
Mailing Address - Fax:
Practice Address - Street 1:703 MILL CREEK RD
Practice Address - Street 2:SUITE H
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3828
Practice Address - Country:US
Practice Address - Phone:609-978-8466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025741001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice