Provider Demographics
NPI:1821144213
Name:SANTOS, REMEDIOS JOSEFINA (DMD)
Entity Type:Individual
Prefix:
First Name:REMEDIOS
Middle Name:JOSEFINA
Last Name:SANTOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:REMEDIOS
Other - Middle Name:JOSEFINA
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:9000 GOLFSIDE DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7793
Mailing Address - Country:US
Mailing Address - Phone:904-367-1722
Mailing Address - Fax:904-367-1739
Practice Address - Street 1:3704 HEATH ROAD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2045
Practice Address - Country:US
Practice Address - Phone:904-743-6380
Practice Address - Fax:904-744-5350
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN97191223G0001X
IDD20601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice