Provider Demographics
NPI:1699795096
Name:SANTA MARIA, JEAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:M
Last Name:SANTA MARIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:606 W WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-2422
Mailing Address - Country:US
Mailing Address - Phone:765-362-5128
Mailing Address - Fax:
Practice Address - Street 1:116 WALTER REMLEY DR
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-3350
Practice Address - Country:US
Practice Address - Phone:765-362-1346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics