Provider Demographics
NPI:1699467043
Name:SANTIAGO, ENRIQUE M (DMD)
Entity type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:M
Last Name:SANTIAGO
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 1:5340 NW 2ND AVE APT 521
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-3894
Mailing Address - Country:US
Mailing Address - Phone:786-975-6948
Mailing Address - Fax:
Practice Address - Street 1:5855 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1020
Practice Address - Country:US
Practice Address - Phone:561-396-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27943122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist