Healthcare Provider Details

I. General information

NPI: 1447276779
Provider Name (Legal Business Name): PEDRO E SANTIAGO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3475 ERWIN RD
DURHAM NC
27705-0005
US

IV. Provider business mailing address

2100 ERWIN RD DUKE UNIVERSITY MEDICAL CENTER, DUMC 3974
DURHAM NC
27705-3941
US

V. Phone/Fax

Practice location:
  • Phone: 919-660-0312
  • Fax: 919-660-0321
Mailing address:
  • Phone: 919-660-0312
  • Fax: 919-660-0321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1787
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8601
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: