MEDICARE: SANTOS DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302F00000X	Exclusive Provider Organization	37909	CA

General Provider Information

NPI Number	:	1164661773
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANTOS DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	450 SUTTER ST RM 1114
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-3913
Country	:	US
Telephone Number	:	415-362-9893
Fax Number	:

Provider Business Practice Location Address
First Line	:	450 SUTTER ST RM 1114
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94108-3913
Country	:	US
Telephone Number	:	415-362-9893
Fax Number	:

Authorized Official
Title or Position	:	DENTIST, OWNER
Name	:	DR. EDNA SANTOS
Credential	:	D.M.D.
Telephone Number	:	415-362-9893

Provider Enumeration Date	:	02/05/2009
Last Update Date	:	06/09/2021

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Directions to “SANTOS DENTAL CORPORATION ” Practice Location

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