Provider Demographics
NPI:1851925481
Name:SANTOS SALSBURY DENTAL CORPORATION
Entity Type:Organization
Organization Name:SANTOS SALSBURY DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:WOLFF
Authorized Official - Last Name:DOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-204-8082
Mailing Address - Street 1:6699 ALVARADO RD STE 2202
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5293
Mailing Address - Country:US
Mailing Address - Phone:619-204-8082
Mailing Address - Fax:
Practice Address - Street 1:6699 ALVARADO RD STE 2202
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5293
Practice Address - Country:US
Practice Address - Phone:619-204-8082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEADER MANAGEMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-22
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental