Provider Demographics
NPI:1982755898
Name:SANTIAGO, ELEAZAR VIRAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELEAZAR
Middle Name:VIRAY
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S. GREEN VALLEY PKWY SUITE #110
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052
Mailing Address - Country:US
Mailing Address - Phone:702-660-7555
Mailing Address - Fax:702-660-7575
Practice Address - Street 1:660 S. GREEN VALLEY PKWY SUITE #110
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-660-7555
Practice Address - Fax:702-660-7575
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ57091223G0001X
NV55341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice