Provider Demographics
NPI:1750534863
Name:SANTIAGO, DAVID (DMD, MDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:DMD, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 AVE AMERICO MIRANDA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-2118
Mailing Address - Country:US
Mailing Address - Phone:787-792-2850
Mailing Address - Fax:787-725-3440
Practice Address - Street 1:1311 AVE AMERICO MIRANDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-2118
Practice Address - Country:US
Practice Address - Phone:787-792-2850
Practice Address - Fax:787-725-3440
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1520OtherLIC