Healthcare Provider Details

I. General information

NPI: 1669831004
Provider Name (Legal Business Name): SANDRA M SANTOS D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2016
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11478 S US HWY 301 S
RIVERVIEW FL
33569
US

IV. Provider business mailing address

2619 OLEANDER LAKES DR
BRANDON FL
33511-1271
US

V. Phone/Fax

Practice location:
  • Phone: 813-957-5913
  • Fax:
Mailing address:
  • Phone: 813-957-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN22343
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: