Provider Demographics
NPI:1962652511
Name:SANTILLANA, RUDY ALBERTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUDY
Middle Name:ALBERTO
Last Name:SANTILLANA
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 1:305 CREEKSIDE DR
Mailing Address - Street 2:A4-1
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-5305
Mailing Address - Country:US
Mailing Address - Phone:973-951-3231
Mailing Address - Fax:
Practice Address - Street 1:305 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-5305
Practice Address - Country:US
Practice Address - Phone:973-951-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31049122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist