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General NPI Number Information
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NPI Number | 1366462343
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Entity Type | Individual
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Provider Name | JUAN I SANTOS DDS
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 331 N MAITLAND AVE STE D4
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City | MAITLAND
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State | FL
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Zip | 32751-4755
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Country | US
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Telephone | 407-644-2614
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Fax | 407-644-1044
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Provider Business Mailing Address
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Address Line | 331 N MAITLAND AVE STE D4
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City | MAITLAND
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State | FL
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Zip | 32751-4755
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Country | US
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Telephone | 407-644-2614
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Fax | 407-644-1044
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN 0012960
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License Number State | FL
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