Provider Demographics
NPI:1932309903
Name:DR. MANUEL R SANTIAGO DENTIST, PSC
Entity Type:Organization
Organization Name:DR. MANUEL R SANTIAGO DENTIST, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEXIDOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-409-0474
Mailing Address - Street 1:88 AVE LAS COLINAS
Mailing Address - Street 2:SANTA PAULA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-5904
Mailing Address - Country:US
Mailing Address - Phone:787-272-0469
Mailing Address - Fax:
Practice Address - Street 1:HG15 CALLE LIZZIE GRAHAM
Practice Address - Street 2:7MA SECCION LEVITTWON
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-3635
Practice Address - Country:US
Practice Address - Phone:787-261-4670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2358261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental