Provider Demographics
NPI:1366462343
Name:SANTOS, JUAN I (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:I
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 1:331 N MAITLAND AVE STE D4
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4755
Mailing Address - Country:US
Mailing Address - Phone:407-644-2614
Mailing Address - Fax:407-644-1044
Practice Address - Street 1:331 N MAITLAND AVE STE D4
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4755
Practice Address - Country:US
Practice Address - Phone:407-644-2614
Practice Address - Fax:407-644-1044
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 00129601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice