Provider Demographics
NPI:1053429886
Name:STEPHANIE L. SANTOS, DDS, PV
Entity type:Organization
Organization Name:STEPHANIE L. SANTOS, DDS, PV
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-499-9639
Mailing Address - Street 1:281 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2986
Mailing Address - Country:US
Mailing Address - Phone:757-499-9639
Mailing Address - Fax:757-490-0808
Practice Address - Street 1:281 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2986
Practice Address - Country:US
Practice Address - Phone:757-499-9639
Practice Address - Fax:757-490-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008019122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty