Provider Demographics
NPI:1851681738
Name:SHIRLEY SANTOS, DDS INC
Entity Type:Organization
Organization Name:SHIRLEY SANTOS, DDS INC
Other - Org Name:SHIRLEY SANTOS,DMD INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:OCAMPO
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-368-0222
Mailing Address - Street 1:17482 IRVINE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3032
Mailing Address - Country:US
Mailing Address - Phone:714-367-0222
Mailing Address - Fax:714-368-0225
Practice Address - Street 1:17482 IRVINE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3032
Practice Address - Country:US
Practice Address - Phone:714-367-0222
Practice Address - Fax:714-368-0225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty