Provider Demographics
NPI:1073744389
Name:ROJO, SANTIAGO AMERICO (DDS)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:AMERICO
Last Name:ROJO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17024 VAN BUREN BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504
Mailing Address - Country:US
Mailing Address - Phone:951-780-5550
Mailing Address - Fax:951-780-5552
Practice Address - Street 1:17024 VAN BUREN BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504
Practice Address - Country:US
Practice Address - Phone:951-780-5550
Practice Address - Fax:951-780-5552
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA582161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice