MEDICARE: DR. DWETTA SANTOS D.M.D.

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	1223G0001X	General Practice Dentistry	30.023668	OH
2	122300000X	Dentist	30.023668	OH

General Provider Information

NPI Number	:	1831487677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DWETTA SANTOS D.M.D.

Provider Business Mailing Address
First Line	:	41 N MAIN ST STE 301
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3016
Country	:	US
Telephone Number	:	440-247-5117
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 N MAIN ST STE 301
Second Line	:
City	:	CHAGRIN FALLS
State	:	OH
Zip	:	44022-3016
Country	:	US
Telephone Number	:	440-247-5117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2011
Last Update Date	:	01/21/2021

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