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General NPI Number Information
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NPI Number | 1932309903
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Entity Type | Organization
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Legal Business Name | DR. MANUEL R SANTIAGO DENTIST, PSC
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Dates
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Enumeration Date | 07/18/2007
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | HG15 CALLE LIZZIE GRAHAM 7MA SECCION LEVITTWON
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City | TOA BAJA
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State | PR
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Zip | 00949-3635
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Country | US
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Telephone | 787-261-4670
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Fax |
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Provider Business Mailing Address
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Address Line | 88 AVE LAS COLINAS SANTA PAULA
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City | GUAYNABO
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State | PR
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Zip | 00969-5904
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Country | US
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Telephone | 787-272-0469
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. YOLANDA TEXIDOR
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Credential |
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Telephone | 787-409-0474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 2358
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License Number State | PR
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