Provider Demographics
NPI:1013331289
Name:SANTANA, VICTOR MANUEL (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:MANUEL
Last Name:SANTANA
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 1:3310 KOSSUTH AVE
Mailing Address - Street 2:56
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2601
Practice Address - Country:US
Practice Address - Phone:347-387-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-09
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04542967Medicaid