Provider Demographics
NPI:1356749840
Name:PINALES, SANTO (DDS)
Entity type:Individual
Prefix:
First Name:SANTO
Middle Name:
Last Name:PINALES
Suffix:
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 1:17628 ROSA DREW LN
Mailing Address - Street 2:APT 35D
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2947
Mailing Address - Country:US
Mailing Address - Phone:949-438-9493
Mailing Address - Fax:
Practice Address - Street 1:1217 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2640
Practice Address - Country:US
Practice Address - Phone:714-550-7172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-15
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64241122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA822214908Medicaid