MEDICARE: DR. AUSTIN DE LOS SANTOS DDS

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	DDS108293	CA

General Provider Information

NPI Number	:	1851008627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN DE LOS SANTOS DDS

Provider Business Mailing Address
First Line	:	27605 PACIFIC COAST HWY
Second Line	:
City	:	MALIBU
State	:	CA
Zip	:	90265-4329
Country	:	US
Telephone Number	:	310-730-3537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 BEVERLY BLVD STE A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2401
Country	:	US
Telephone Number	:	213-484-2919
Fax Number	:

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

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	11/01/2022

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