Provider Demographics
NPI:1508273046
Name:RUBEN R. SANTANA, DMD, INC.
Entity Type:Organization
Organization Name:RUBEN R. SANTANA, DMD, INC.
Other - Org Name:4TH-VERMONT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANTANA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:213-386-1418
Mailing Address - Street 1:356 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1807
Mailing Address - Country:US
Mailing Address - Phone:213-386-1418
Mailing Address - Fax:213-386-1417
Practice Address - Street 1:356 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1807
Practice Address - Country:US
Practice Address - Phone:213-386-1418
Practice Address - Fax:213-386-1417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37495122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty