Provider Demographics
NPI:1538577663
Name:MARIA LUISA B. SANTOS,DMD, INC
Entity type:Organization
Organization Name:MARIA LUISA B. SANTOS,DMD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA LUISA
Authorized Official - Middle Name:BUGARIN
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:650-873-4740
Mailing Address - Street 1:1001 SAN BRUNO AVE W
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-3318
Mailing Address - Country:US
Mailing Address - Phone:650-873-4740
Mailing Address - Fax:650-873-3179
Practice Address - Street 1:1001 SAN BRUNO AVE W
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-3318
Practice Address - Country:US
Practice Address - Phone:650-873-4740
Practice Address - Fax:650-873-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty