Provider Demographics
NPI:1457542581
Name:MARIA V. SANTOS, D.M.D., INC
Entity Type:Organization
Organization Name:MARIA V. SANTOS, D.M.D., INC
Other - Org Name:VICTORY DENTAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:SORIANO
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-871-8093
Mailing Address - Street 1:1103 W ORANGETHORPE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4735
Mailing Address - Country:US
Mailing Address - Phone:714-871-8093
Mailing Address - Fax:
Practice Address - Street 1:1103 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4735
Practice Address - Country:US
Practice Address - Phone:714-871-8093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB390781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty