Provider Demographics
NPI:1275551657
Name:ROGER P. SANTISE, D.D.S., P.A.
Entity Type:Organization
Organization Name:ROGER P. SANTISE, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:P
Authorized Official - Last Name:SANTISE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-664-1808
Mailing Address - Street 1:333 OLD HOOK RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-3200
Mailing Address - Country:US
Mailing Address - Phone:201-664-1808
Mailing Address - Fax:201-664-6669
Practice Address - Street 1:333 OLD HOOK RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3200
Practice Address - Country:US
Practice Address - Phone:201-664-1808
Practice Address - Fax:201-664-6669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ93181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty