Healthcare Provider Details

I. General information

NPI: 1356682082
Provider Name (Legal Business Name): MIGUEL JESUS SANTAMARINA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 FORUM WAY SUITE 800
WEST PALM BEACH FL
33401-2325
US

IV. Provider business mailing address

1401 FORUM WAY SUITE 800
WEST PALM BEACH FL
33401
US

V. Phone/Fax

Practice location:
  • Phone: 561-682-0999
  • Fax: 561-683-0899
Mailing address:
  • Phone: 561-682-0999
  • Fax: 561-683-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN0011359
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: