Provider Demographics
NPI:1598957276
Name:HABASHY-SANTIAGO, MICHELINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHELINE
Middle Name:
Last Name:HABASHY-SANTIAGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4007 WESTMORELAND ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1736
Mailing Address - Country:US
Mailing Address - Phone:718-279-9503
Mailing Address - Fax:718-279-9503
Practice Address - Street 1:4007 WESTMORELAND ST
Practice Address - Street 2:
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11363-1736
Practice Address - Country:US
Practice Address - Phone:718-279-9503
Practice Address - Fax:718-279-9503
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0455731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice