Provider Demographics
NPI:1134811839
Name:SANTOS, MCKAILA TILLIE (DMD)
Entity type:Individual
Prefix:DR
First Name:MCKAILA
Middle Name:TILLIE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MCKAILA
Other - Middle Name:TILLIE
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:4700 KENILWORTH DR APT 110
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3325
Mailing Address - Country:US
Mailing Address - Phone:630-450-0793
Mailing Address - Fax:
Practice Address - Street 1:412 CRYSTAL ST
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-2023
Practice Address - Country:US
Practice Address - Phone:847-516-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-22
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019034224122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist