Provider Demographics
NPI:1376606020
Name:GRANA SANTIAGO, LUIS ALBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALBERTO
Last Name:GRANA SANTIAGO
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:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-0162
Mailing Address - Country:US
Mailing Address - Phone:787-897-1810
Mailing Address - Fax:787-897-1810
Practice Address - Street 1:22 CALLE PEDRO ALBIZU CAMPOS
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-2105
Practice Address - Country:US
Practice Address - Phone:787-897-1810
Practice Address - Fax:787-897-1810
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice