Provider Demographics
NPI:1326096959
Name:SANTIAGO, IRMA I (DMD)
Entity Type:Individual
Prefix:DR
First Name:IRMA
Middle Name:I
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 1:14 AVE MIGUEL MELENDEZ MUNOZ
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4604
Mailing Address - Country:US
Mailing Address - Phone:787-263-0667
Mailing Address - Fax:787-263-0667
Practice Address - Street 1:14 AVE MIGUEL MELENDEZ MUNOZ
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4604
Practice Address - Country:US
Practice Address - Phone:787-263-0667
Practice Address - Fax:787-263-0667
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2466122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist