Provider Demographics
NPI:1851713747
Name:SANTOS PERES, MARIA FERNANDA
Entity Type:Individual
Prefix:
First Name:MARIA FERNANDA
Middle Name:
Last Name:SANTOS PERES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 W MEMORIAL RD APT 113
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-6403
Mailing Address - Country:US
Mailing Address - Phone:405-441-9800
Mailing Address - Fax:
Practice Address - Street 1:1201 N STONEWALL AVE RM 542
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1214
Practice Address - Country:US
Practice Address - Phone:405-271-4544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKVF21223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics