Provider Demographics
NPI:1023158722
Name:SANTOS, EDELYN MANUEL (DDS)
Entity type:Individual
Prefix:DR
First Name:EDELYN
Middle Name:MANUEL
Last Name:SANTOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4287 GEORGE AVE
Mailing Address - Street 2:#2
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-4698
Mailing Address - Country:US
Mailing Address - Phone:650-867-2128
Mailing Address - Fax:
Practice Address - Street 1:33341 ALVARADO NILES RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3195
Practice Address - Country:US
Practice Address - Phone:510-471-9300
Practice Address - Fax:510-471-9300
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist