Healthcare Provider Details

I. General information

NPI: 1093711335
Provider Name (Legal Business Name): JOSE JAVIER SANTIAGO DMD, MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 AVE MIGUEL MELENDEZ MUNOZ
CAYEY PR
00736-4619
US

IV. Provider business mailing address

2 AVE MIGUEL MELENDEZ MUNOZ
CAYEY PR
00736-4619
US

V. Phone/Fax

Practice location:
  • Phone: 787-738-4914
  • Fax:
Mailing address:
  • Phone: 787-738-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2672
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: