MEDICARE: DR. MARBEA SANTOS DAZO D.D.S.

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	44470	CA

General Provider Information

NPI Number	:	1962622662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARBEA SANTOS DAZO D.D.S.

Provider Business Mailing Address
First Line	:	17214 NORWALK BLVD
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-2718
Country	:	US
Telephone Number	:	562-860-6011
Fax Number	:	562-860-7221

Provider Business Practice Location Address
First Line	:	17214 NORWALK BLVD
Second Line	:
City	:	CERRITOS
State	:	CA
Zip	:	90703-2718
Country	:	US
Telephone Number	:	562-860-6011
Fax Number	:	562-860-7221

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. MARBEA SANTOS DAZO D.D.S.” Practice Location

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