Provider Demographics
NPI:1659401842
Name:CORTEZ, SANTOS (DDS)
Entity Type:Individual
Prefix:
First Name:SANTOS
Middle Name:
Last Name:CORTEZ
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 1:8032 E ROSINA ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-3253
Mailing Address - Country:US
Mailing Address - Phone:562-377-1375
Mailing Address - Fax:
Practice Address - Street 1:3320 N LOS COYOTES DIAGONAL
Practice Address - Street 2:SUITE 200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3918
Practice Address - Country:US
Practice Address - Phone:562-377-1375
Practice Address - Fax:562-377-1353
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1922116730OtherPRACTICE NPI
CAB25498Medicare ID - Type Unspecified