Provider Demographics
NPI:1598276495
Name:MAURICIO DOSSANTOS DDS INC.
Entity Type:Organization
Organization Name:MAURICIO DOSSANTOS DDS INC.
Other - Org Name:DOSSANTOS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-790-1951
Mailing Address - Street 1:12033 4TH ST
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2755
Mailing Address - Country:US
Mailing Address - Phone:909-790-1951
Mailing Address - Fax:909-790-1561
Practice Address - Street 1:12033 4TH ST
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2755
Practice Address - Country:US
Practice Address - Phone:909-790-1951
Practice Address - Fax:909-790-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61711261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental