Healthcare Provider Details

I. General information

NPI: 1750534863
Provider Name (Legal Business Name): DAVID SANTIAGO DMD, MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2008
Last Update Date: 11/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 AVE AMERICO MIRANDA
SAN JUAN PR
00921-2118
US

IV. Provider business mailing address

1311 AVE AMERICO MIRANDA
SAN JUAN PR
00921-2118
US

V. Phone/Fax

Practice location:
  • Phone: 787-792-2850
  • Fax: 787-725-3440
Mailing address:
  • Phone: 787-792-2850
  • Fax: 787-725-3440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1520
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: