MEDICARE: VICTOR DE LOS SANTOS D.D.S. INC

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	36534	CA

General Provider Information

NPI Number	:	1558727453
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTOR DE LOS SANTOS D.D.S. INC

Provider Business Mailing Address
First Line	:	3712 ATLANTIC AVE
Second Line	:	STE C
City	:	LONG BEACH
State	:	CA
Zip	:	90807-6671
Country	:	US
Telephone Number	:	562-426-1298
Fax Number	:	562-426-4131

Provider Business Practice Location Address
First Line	:	3712 ATLANTIC AVE
Second Line	:	STE C
City	:	LONG BEACH
State	:	CA
Zip	:	90807-6671
Country	:	US
Telephone Number	:	562-426-1298
Fax Number	:	562-426-4131

Authorized Official
Title or Position	:	OWNER/DENTUST
Name	:	DR. VICTOR DE LOS SANTOS
Credential	:	DDS
Telephone Number	:	562-426-1298

Provider Enumeration Date	:	01/07/2016
Last Update Date	:	01/07/2016

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