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General NPI Number Information
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NPI Number | 1699467043
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Entity Type | Individual
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Provider Name | ENRIQUE M. SANTIAGO DMD
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Gender | Male
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Dates
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Enumeration Date | 05/24/2023
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Last Update Date | 05/26/2023
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Provider Practice Location Address
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Address Line | 5855 20TH ST
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City | VERO BEACH
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State | FL
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Zip | 32966-1020
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Country | US
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Telephone | 561-396-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 5340 NW 2ND AVE APT 521
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City | BOCA RATON
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State | FL
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Zip | 33487-3894
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Country | US
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Telephone | 786-975-6948
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27943
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License Number State | FL
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