Individual provider Active NPI

Juan I Santos, DDS

  • General Practice Dentistry
  • Maitland, FL
National Provider Identifier
1366462343
Registry record updated Jan 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN 0012960 Issued in FL
Practice address
331 N Maitland Ave Ste D4
Maitland, FL 32751-4755
Phone
(407) 644-2614
Fax
(407) 644-1044
NPI assigned
Jul 20, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN 0012960 FL Primary

Addresses

Primary practice location

331 N Maitland Ave Ste D4
Maitland, FL 32751-4755

Mailing address

331 N Maitland Ave Ste D4
Maitland, FL 32751-4755
Phone (407) 644-2614

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DN 0012960FLMDGeneral Practice Dentistry

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17948/brand/1/csg/1/fhir/r4

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325808000000",
    "number": "1366462343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 N MAITLAND AVE STE D4",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514755",
            "telephone_number": "407-644-2614",
            "fax_number": "407-644-1044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 N MAITLAND AVE STE D4",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327514755",
            "telephone_number": "407-644-2614",
            "fax_number": "407-644-1044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTOS",
        "first_name": "JUAN",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2012-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 0012960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maitland, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.