Provider Demographics
NPI:1598975476
Name:SANTOS, SHIRLEY OCAMPO (DDS)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:OCAMPO
Last Name:SANTOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17482 IRVINE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3032
Mailing Address - Country:US
Mailing Address - Phone:714-368-0222
Mailing Address - Fax:714-368-0225
Practice Address - Street 1:17482 IRVINE BLVD STE B
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3032
Practice Address - Country:US
Practice Address - Phone:714-368-0222
Practice Address - Fax:714-368-0225
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice