Provider Demographics
NPI:1447649454
Name:DELOS SANTOS, JOSE E (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:DELOS SANTOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSE
Other - Middle Name:EU
Other - Last Name:DELOS SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2105 N CITRUS RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9204
Mailing Address - Country:US
Mailing Address - Phone:623-853-0304
Mailing Address - Fax:
Practice Address - Street 1:15717 W JENAN DR
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-1026
Practice Address - Country:US
Practice Address - Phone:623-399-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD06750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist