MEDICARE: DR. GERALD ANTHONY SANTULLI D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9174	MD
2	1223P0700X	Prosthodontics	0401008190	VA

General Provider Information

NPI Number	:	1154300044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD ANTHONY SANTULLI D.M.D

Provider Business Mailing Address
First Line	:	1607 NORAL PL
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-1800
Country	:	US
Telephone Number	:	703-360-0790
Fax Number	:

Provider Business Practice Location Address
First Line	:	5802 ARMY PENTAGON
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20310-5802
Country	:	US
Telephone Number	:	703-692-8739
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	09/11/2025

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