Healthcare Provider Details

I. General information

NPI: 1952484925
Provider Name (Legal Business Name): JOEL SANTOS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N JACKSON AVE D
SAN JOSE CA
95116-1601
US

IV. Provider business mailing address

200 N JACKSON AVE D
SAN JOSE CA
95116-1601
US

V. Phone/Fax

Practice location:
  • Phone: 408-254-7491
  • Fax: 408-251-7859
Mailing address:
  • Phone: 408-254-7491
  • Fax: 408-251-7859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number38596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: