Healthcare Provider Details

I. General information

NPI: 1487920047
Provider Name (Legal Business Name): EVE MARINA SANTOS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 PINE ST
DANVILLE PA
17821
US

IV. Provider business mailing address

444 PINE ST
DANVILLE PA
17821-2219
US

V. Phone/Fax

Practice location:
  • Phone: 570-275-2600
  • Fax:
Mailing address:
  • Phone: 570-275-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number056788
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: