MEDICARE: DR. JOSE E SANTANA DDS . FCH.

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	NY046391	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942344411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSE E SANTANA DDS . FCH.

Provider Business Mailing Address
First Line	:	7115 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1608
Country	:	US
Telephone Number	:	718-833-8100
Fax Number	:	718-833-8280

Provider Business Practice Location Address
First Line	:	7115 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-1608
Country	:	US
Telephone Number	:	718-833-8100
Fax Number	:	718-833-8280

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

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	07/08/2007

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