Provider Demographics
NPI:1356682082
Name:SANTAMARINA, MIGUEL JESUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:JESUS
Last Name:SANTAMARINA
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 1:1401 FORUM WAY
Mailing Address - Street 2:SUITE 800
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-682-0999
Mailing Address - Fax:561-683-0899
Practice Address - Street 1:1401 FORUM WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2325
Practice Address - Country:US
Practice Address - Phone:561-682-0999
Practice Address - Fax:561-683-0899
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0011359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist