Provider Demographics
NPI:1538541891
Name:SANTOS, NINA-CECILIA VENTURINA I (DDS)
Entity type:Individual
Prefix:DR
First Name:NINA-CECILIA
Middle Name:VENTURINA
Last Name:SANTOS
Suffix:I
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4844 ATTENBOROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6870
Mailing Address - Country:US
Mailing Address - Phone:443-629-5894
Mailing Address - Fax:
Practice Address - Street 1:8114 SANDPIPER CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4934
Practice Address - Country:US
Practice Address - Phone:410-931-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-23
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15901122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist