Healthcare Provider Details

I. General information

NPI: 1578827176
Provider Name (Legal Business Name): SCOTT N SANTOS DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S HOLLADAY DR
SEASIDE OR
97138-6729
US

IV. Provider business mailing address

427 S HOLLADAY DR
SEASIDE OR
97138-6729
US

V. Phone/Fax

Practice location:
  • Phone: 503-738-6733
  • Fax: 503-738-7617
Mailing address:
  • Phone: 503-738-6733
  • Fax: 503-738-7617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberD8236
License Number StateOR

VIII. Authorized Official

Name: DR. SCOTT N SANTOS
Title or Position: OWNER
Credential: DDS
Phone: 503-738-6733