Provider Demographics
NPI:1407922644
Name:SANTOS, ESTELITO MORENO JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ESTELITO
Middle Name:MORENO
Last Name:SANTOS
Suffix:JR
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 1:500 COPELAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23322
Mailing Address - Country:US
Mailing Address - Phone:757-548-6315
Mailing Address - Fax:
Practice Address - Street 1:1300 KEMPSVILLE RD STE 1
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6199
Practice Address - Country:US
Practice Address - Phone:757-467-8181
Practice Address - Fax:800-879-3455
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist