Provider Demographics
NPI:1831216134
Name:DESANTOS, MANUEL FRANCIS (DDS)
Entity type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:FRANCIS
Last Name:DESANTOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MANUEL
Other - Middle Name:F
Other - Last Name:DESANTOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:355 CAMPUS DR
Mailing Address - Street 2:#C
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-4347
Mailing Address - Country:US
Mailing Address - Phone:559-587-9848
Mailing Address - Fax:559-587-9862
Practice Address - Street 1:355 CAMPUS DR
Practice Address - Street 2:#C
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-4347
Practice Address - Country:US
Practice Address - Phone:559-587-9848
Practice Address - Fax:559-587-9862
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38831122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist