MEDICARE: DR. MCKAILA TILLIE SANTOS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019034224	IL

General Provider Information

NPI Number	:	1134811839
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MCKAILA TILLIE SANTOS DMD

Provider Business Mailing Address
First Line	:	412 CRYSTAL ST
Second Line	:
City	:	CARY
State	:	IL
Zip	:	60013-2023
Country	:	US
Telephone Number	:	630-450-0793
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 CRYSTAL ST
Second Line	:
City	:	CARY
State	:	IL
Zip	:	60013-2023
Country	:	US
Telephone Number	:	847-516-1100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2023
Last Update Date	:	05/04/2026

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