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General NPI Number Information
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NPI Number | 1730286634
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Entity Type | Individual
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Provider Name | GARY PETER SANTA MARIA DMD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 64 MAPLE ST
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City | PLAINVILLE
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State | CT
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Zip | 06062
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Country | US
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Telephone | 860-747-2416
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Fax | 860-747-8852
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Provider Business Mailing Address
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Address Line | 40 INDIAN HILL RD
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City | FARMINGTON
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State | CT
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Zip | 06032
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Country | US
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Telephone | 860-674-8988
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Fax | 860-674-8988
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 008639
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License Number State | CT
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