Provider Demographics
NPI:1386854842
Name:SANTORA, THOMAS G (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:SANTORA
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 1:511 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:ROSELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07204-1927
Mailing Address - Country:US
Mailing Address - Phone:908-245-1012
Mailing Address - Fax:908-245-0541
Practice Address - Street 1:511 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:ROSELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07204-1927
Practice Address - Country:US
Practice Address - Phone:908-245-1012
Practice Address - Fax:908-245-0541
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ94641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice