Provider Demographics
NPI:1417961640
Name:SANTONE, JACK M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:M
Last Name:SANTONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 SANTA FE DR
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3842
Mailing Address - Country:US
Mailing Address - Phone:760-753-0136
Mailing Address - Fax:760-753-1838
Practice Address - Street 1:891 SANTA FE DR
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3842
Practice Address - Country:US
Practice Address - Phone:760-753-0136
Practice Address - Fax:760-753-1838
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD191601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice