Provider Demographics
NPI:1851008627
Name:DE LOS SANTOS, AUSTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:
Last Name:DE LOS SANTOS
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 1:27605 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-4329
Mailing Address - Country:US
Mailing Address - Phone:310-730-3537
Mailing Address - Fax:
Practice Address - Street 1:1919 BEVERLY BLVD STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2401
Practice Address - Country:US
Practice Address - Phone:213-484-2919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS108293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist