Healthcare Provider Details

I. General information

NPI: 1639868128
Provider Name (Legal Business Name): JONATHAN JAVIER SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2023
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BB25 AVENIDA SANTA JUANITA
BAYAMON PR
00956-4633
US

IV. Provider business mailing address

URB SAN FERNANO F-6 AVENIDA HERMANAS DAVILA
BAYAMON PR
00957-2203
US

V. Phone/Fax

Practice location:
  • Phone: 787-787-9043
  • Fax:
Mailing address:
  • Phone: 787-450-0175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3566
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: