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General NPI Number Information
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NPI Number | 1851713747
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Entity Type | Individual
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Provider Name | MARIA FERNANDA SANTOS PERES
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Gender | Female
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 1201 N STONEWALL AVE RM 542
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City | OKLAHOMA CITY
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State | OK
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Zip | 73117-1214
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Country | US
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Telephone | 405-271-4544
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Fax |
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Provider Business Mailing Address
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Address Line | 6700 W MEMORIAL RD APT 113
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City | OKLAHOMA CITY
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State | OK
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Zip | 73142-6403
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Country | US
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Telephone | 405-441-9800
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Fax |
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | VF2
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License Number State | OK
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