Provider Demographics
NPI:1508169798
Name:ANTHONY A SANTORSOLA, DDS
Entity Type:Organization
Organization Name:ANTHONY A SANTORSOLA, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-525-2813
Mailing Address - Street 1:5723 NE BOTHELL WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-9404
Mailing Address - Country:US
Mailing Address - Phone:206-525-2813
Mailing Address - Fax:425-483-1414
Practice Address - Street 1:5723 NE BOTHELL WAY
Practice Address - Street 2:SUITE A
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-9404
Practice Address - Country:US
Practice Address - Phone:206-525-2813
Practice Address - Fax:425-483-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6023017971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty