MEDICARE: REMEDIOS JOSEFINA 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	1223G0001X	General Practice Dentistry	DN9719	FL
2	1223G0001X	General Practice Dentistry	D2060	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821144213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REMEDIOS JOSEFINA SANTOS DMD

Provider Business Mailing Address
First Line	:	9000 GOLFSIDE DRIVE
Second Line	:	SUITE B
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7793
Country	:	US
Telephone Number	:	904-367-1722
Fax Number	:	904-367-1739

Provider Business Practice Location Address
First Line	:	3704 HEATH ROAD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2045
Country	:	US
Telephone Number	:	904-743-6380
Fax Number	:	904-744-5350

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	11/04/2010

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