Provider Demographics
NPI:1174135412
Name:EARL P SANTOS DMD PA
Entity type:Organization
Organization Name:EARL P SANTOS DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-513-5494
Mailing Address - Street 1:1393 KITTERY CT
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-2623
Mailing Address - Country:US
Mailing Address - Phone:412-513-5494
Mailing Address - Fax:
Practice Address - Street 1:2535 LANDMARK DR STE 104
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3930
Practice Address - Country:US
Practice Address - Phone:727-791-1450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental