Provider Demographics
NPI:1093789620
Name:SANTA MARIA, ALBERTO LAZARO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALBERTO
Middle Name:LAZARO
Last Name:SANTA MARIA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE LOPATEGUI
Mailing Address - Street 2:#50 COND. PARKVILLE PLAZA #508
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4595
Mailing Address - Country:US
Mailing Address - Phone:787-250-1849
Mailing Address - Fax:
Practice Address - Street 1:AVE. SAN PATRICIO
Practice Address - Street 2:101 MARAMAR PLAZA #903
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-250-1849
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR3146Medicare UPIN