Provider Demographics
NPI:1720179658
Name:SANTOS, JEFFREY H
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:H
Last Name:SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1614
Mailing Address - Country:US
Mailing Address - Phone:650-322-7716
Mailing Address - Fax:650-322-2635
Practice Address - Street 1:409 CAMBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1614
Practice Address - Country:US
Practice Address - Phone:650-322-7716
Practice Address - Fax:650-322-2635
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice