Ivan Jonathan Santos, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

100036 Issued in CA

Practice address

12110 Woodside Ave
Lakeside, CA 92040-3012

Phone

(619) 443-0444

Fax

(619) 443-0050

NPI assigned

Feb 11, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arthur Santos DDS Corp

  • Dental Clinic/Center
  • Lakeside, CA
  • NPI 1770940637
  NPD
• Blackstockdentalcorp

  • General Practice Dentistry
  • Lakeside, CA
  • NPI 1417168881
  NPD (past)

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

{
    "created_epoch": "1455148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455148800000",
    "number": "1659730182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6833 FASHION HILLS BLVD",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921117651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12110 WOODSIDE AVE",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920403012",
            "telephone_number": "619-443-0444",
            "fax_number": "619-443-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTOS",
        "first_name": "IVAN",
        "middle_name": "JONATHAN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-11",
        "last_updated": "2016-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "100036",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• San Diego Center for Neurofeedback
• San Diego Detox LLC
• San Diego Detox LLC
• San Diego Detox LLC
• San Diego Detox LLC
• Lindsey Michelle Shamp
• Tabitha Shannon, RN
• Steve Chia-Hua Shiue, MD
• Sean Arthur Smith
• Thais Dinese St Martin, MASTERS OF SCIENCE

• Dentist in Lakeside, CA
• Providers in Lakeside, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.