Provider Demographics
NPI:1083686380
Name:SANTORO, JOHN A (DDS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:SANTORO
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 1:14525 SIBLEY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193
Mailing Address - Country:US
Mailing Address - Phone:734-479-2222
Mailing Address - Fax:734-479-2112
Practice Address - Street 1:14525 SIBLEY RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193
Practice Address - Country:US
Practice Address - Phone:734-479-2222
Practice Address - Fax:734-479-2112
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010117331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry