Healthcare Provider Details

I. General information

NPI: 1235212176
Provider Name (Legal Business Name): STEVEN J SANTUCCI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 S BROAD ST
TRENTON NJ
08611-1410
US

IV. Provider business mailing address

1100 S BROAD ST
TRENTON NJ
08611-1410
US

V. Phone/Fax

Practice location:
  • Phone: 609-393-6404
  • Fax: 609-393-6424
Mailing address:
  • Phone: 609-393-6404
  • Fax: 609-393-6424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI01310100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: