=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164723474
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHRISTIAN SANTANA D D S P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/03/2010
-----------------------------------------------------
Last Update Date | 10/30/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 E BROAD ST STE C
-----------------------------------------------------
City | HAZLETON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18201-6511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-497-4081
-----------------------------------------------------
Fax | 570-497-4082
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 E BROAD ST STE C
-----------------------------------------------------
City | HAZLETON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18201-6511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 570-497-4081
-----------------------------------------------------
Fax | 570-497-4082
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST PRESIDENT
-----------------------------------------------------
Name | DR. CHRISTIAN F SANTANA
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 570-497-4081
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------