Provider Demographics
NPI:1922094150
Name:SANTIAGO MARTINEZ, HERIBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:HERIBERTO
Middle Name:
Last Name:SANTIAGO MARTINEZ
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 3139
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-3139
Mailing Address - Country:US
Mailing Address - Phone:787-866-3777
Mailing Address - Fax:787-686-6010
Practice Address - Street 1:1 CALLE SAN ANTONIO N
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4719
Practice Address - Country:US
Practice Address - Phone:787-866-3777
Practice Address - Fax:787-686-6010
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR20941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice