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General NPI Number Information
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NPI Number | 1073979472
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Entity Type | Organization
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Legal Business Name | RUBENCILLO H SANTOS DDS INC
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 2503 E HATCH RD
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City | MODESTO
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State | CA
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Zip | 95351-4817
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Country | US
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Telephone | 209-537-5783
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Fax | 209-537-0443
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Provider Business Mailing Address
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Address Line | 2503 E HATCH RD
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City | MODESTO
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State | CA
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Zip | 95351-4817
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Country | US
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Telephone | 209-537-5783
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Fax | 209-537-0443
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUBENCILLO HERRERA SANTOS
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Credential | DDS
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Telephone | 209-537-5783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 59933
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License Number State | CA
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