Provider Demographics
NPI:1093711335
Name:SANTIAGO, JOSE JAVIER (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:JAVIER
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AVE MIGUEL MELENDEZ MUNOZ
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4619
Mailing Address - Country:US
Mailing Address - Phone:787-738-4914
Mailing Address - Fax:
Practice Address - Street 1:2 AVE MIGUEL MELENDEZ MUNOZ
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4619
Practice Address - Country:US
Practice Address - Phone:787-738-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26721223X0400X
NY515111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics