MEDICARE: DR. MIGUEL JOSE SANTAELLA D.D.S

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	1728	PR

General Provider Information

NPI Number	:	1376655738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIGUEL JOSE SANTAELLA D.D.S

Provider Business Mailing Address
First Line	:	PO BOX 9066590
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00906-6590
Country	:	US
Telephone Number	:	787-620-2500
Fax Number	:	787-620-2500

Provider Business Practice Location Address
First Line	:	CARR.PR #165, CITY VIEW PLAZA
Second Line	:	SUITE 415
City	:	GUAYNABO
State	:	PR
Zip	:	00968-0000
Country	:	US
Telephone Number	:	787-620-2500
Fax Number	:	787-620-2505

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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