Provider Demographics
NPI:1700239076
Name:SANTOS, KIRA (DMD)
Entity Type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KIRA
Other - Middle Name:
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3705 SW 27TH ST
Mailing Address - Street 2:APT 411
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-7027
Mailing Address - Country:US
Mailing Address - Phone:954-756-0513
Mailing Address - Fax:
Practice Address - Street 1:3705 SW 27TH ST
Practice Address - Street 2:APT 411
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-7027
Practice Address - Country:US
Practice Address - Phone:954-756-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist