Provider Demographics
NPI:1275500985
Name:SANTIAGO, ROBIN MARK (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:MARK
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 FARMINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1418
Mailing Address - Country:US
Mailing Address - Phone:860-232-4511
Mailing Address - Fax:860-236-0482
Practice Address - Street 1:901 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1418
Practice Address - Country:US
Practice Address - Phone:860-232-4511
Practice Address - Fax:860-236-0482
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice