Provider Demographics
NPI:1831398569
Name:SANTANA, YAIRA JULISSA (DMD)
Entity type:Individual
Prefix:DR
First Name:YAIRA
Middle Name:JULISSA
Last Name:SANTANA
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:PO BOX 8582
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00792-8582
Mailing Address - Country:US
Mailing Address - Phone:787-594-6602
Mailing Address - Fax:787-733-5566
Practice Address - Street 1:208 CALLE MONTECARLO
Practice Address - Street 2:PALMAS DEL MAR
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-6189
Practice Address - Country:US
Practice Address - Phone:787-594-6602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice