Provider Demographics
NPI:1770182529
Name:WILLIAMS, VIRGINIA SANTIAGO (PROPHY TECH)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:SANTIAGO
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PROPHY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 555221
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5221
Mailing Address - Country:US
Mailing Address - Phone:760-725-2569
Mailing Address - Fax:
Practice Address - Street 1:21 AREA DENTAL CLINIC
Practice Address - Street 2:BLDG 210735 C ST
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5221
Practice Address - Country:US
Practice Address - Phone:760-725-2569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant