Healthcare Provider Details

I. General information

NPI: 1912823360
Provider Name (Legal Business Name): SANTIAGO A ALCANTARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 MEDICAL CENTER ROAD BUILDING 36065
APO AA
76544
US

IV. Provider business mailing address

590 MEDICAL CENTER ROAD BUILDING 36065
APO AA
76544
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8000
  • Fax:
Mailing address:
  • Phone: 254-288-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: