Provider Demographics
NPI:1720268519
Name:SANTOS, MARIA LUISA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARIA LUISA
Middle Name:B
Last Name:SANTOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10082 CROSBY AVE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1060
Mailing Address - Country:US
Mailing Address - Phone:714-590-8596
Mailing Address - Fax:650-991-7497
Practice Address - Street 1:10082 CROSBY AVE
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1060
Practice Address - Country:US
Practice Address - Phone:714-590-8596
Practice Address - Fax:650-991-7497
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55873122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist