Healthcare Provider Details

I. General information

NPI: 1154300044
Provider Name (Legal Business Name): GERALD ANTHONY SANTULLI D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 ARMY PENTAGON
WASHINGTON DC
20310-5802
US

IV. Provider business mailing address

1607 NORAL PL
ALEXANDRIA VA
22308-1800
US

V. Phone/Fax

Practice location:
  • Phone: 703-692-8739
  • Fax:
Mailing address:
  • Phone: 703-360-0790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9174
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401008190
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: