Provider Demographics
NPI:1023167368
Name:DE LOS SANTOS, RENE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RENE
Middle Name:
Last Name:DE LOS SANTOS
Suffix:JR
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 1:191 E PRICE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3527
Mailing Address - Country:US
Mailing Address - Phone:956-548-7400
Mailing Address - Fax:956-621-3689
Practice Address - Street 1:191 E PRICE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3527
Practice Address - Country:US
Practice Address - Phone:956-548-7400
Practice Address - Fax:956-621-3689
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160087604Medicaid
TX648758OtherMEDICARE