Provider Demographics
NPI:1821729088
Name:SANTORA, CODY
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:
Last Name:SANTORA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 GARDEN GATE CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8629
Mailing Address - Country:US
Mailing Address - Phone:850-477-7574
Mailing Address - Fax:
Practice Address - Street 1:911 GARDEN GATE CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8629
Practice Address - Country:US
Practice Address - Phone:850-477-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL271141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice