Provider Demographics
NPI:1942344411
Name:SANTANA, JOSE E (DDS FCH)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:E
Last Name:SANTANA
Suffix:
Gender:M
Credentials:DDS FCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1608
Mailing Address - Country:US
Mailing Address - Phone:718-833-8100
Mailing Address - Fax:718-833-8280
Practice Address - Street 1:7115 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1608
Practice Address - Country:US
Practice Address - Phone:718-833-8100
Practice Address - Fax:718-833-8280
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY0463911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01916210Medicaid