Provider Demographics
NPI:1184386732
Name:MORENO SANTANDER, LILIANA ALEXANDRA
Entity type:Individual
Prefix:
First Name:LILIANA
Middle Name:ALEXANDRA
Last Name:MORENO SANTANDER
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 1:226 COLBERT ST
Mailing Address - Street 2:
Mailing Address - City:TANEYTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21787-2615
Mailing Address - Country:US
Mailing Address - Phone:443-717-0512
Mailing Address - Fax:
Practice Address - Street 1:401 CARPENTER RD BLDG 525
Practice Address - Street 2:
Practice Address - City:FORT MYER
Practice Address - State:VA
Practice Address - Zip Code:22211-1009
Practice Address - Country:US
Practice Address - Phone:703-696-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH22568124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist