Provider Demographics
NPI:1063542611
Name:SANTORO, ROBERT J (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:SANTORO
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 1:6244 EL CAJON BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3918
Mailing Address - Country:US
Mailing Address - Phone:619-583-1100
Mailing Address - Fax:619-583-8301
Practice Address - Street 1:6244 EL CAJON BLVD
Practice Address - Street 2:STE 1
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92115-3918
Practice Address - Country:US
Practice Address - Phone:619-583-1100
Practice Address - Fax:619-583-8301
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice