Provider Demographics
NPI:1922341460
Name:SANTIAGO, GERMAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GERMAINE
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10470 NW 58TH TER
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2828
Mailing Address - Country:US
Mailing Address - Phone:939-475-0095
Mailing Address - Fax:
Practice Address - Street 1:10470 NW 58TH TER
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2828
Practice Address - Country:US
Practice Address - Phone:939-475-0095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27981223G0001X
FLDN 204751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice