Provider Demographics
NPI:1750461745
Name:DANIEL R SANTARELLI DDS. SC
Entity Type:Organization
Organization Name:DANIEL R SANTARELLI DDS. SC
Other - Org Name:SANTARELLI DENTAL SC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANTARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-654-4340
Mailing Address - Street 1:624 75TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-6025
Mailing Address - Country:US
Mailing Address - Phone:262-654-4340
Mailing Address - Fax:262-654-4530
Practice Address - Street 1:624 75TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143-6025
Practice Address - Country:US
Practice Address - Phone:262-654-4340
Practice Address - Fax:262-654-4530
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DANIEL R SANTARELLI DDS. SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-16
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty