Provider Demographics
NPI:1275600595
Name:SANTIAGO-PATTERSON, MANUAL (DMD)
Entity type:Individual
Prefix:DR
First Name:MANUAL
Middle Name:
Last Name:SANTIAGO-PATTERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SARATOGA VILLAGE BLVD
Mailing Address - Street 2:SUITE 36A
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-3737
Mailing Address - Country:US
Mailing Address - Phone:518-899-9783
Mailing Address - Fax:518-899-4007
Practice Address - Street 1:489 BERNARDSTON RD
Practice Address - Street 2:CHERRY RUM PLAZA
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1234
Practice Address - Country:US
Practice Address - Phone:413-773-3850
Practice Address - Fax:413-773-5300
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice