Provider Demographics
NPI:1992167704
Name:RICHARD D. SANTI, D.D.S., P.C.
Entity type:Organization
Organization Name:RICHARD D. SANTI, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-852-2558
Mailing Address - Street 1:10 RUPERT ST
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-1042
Mailing Address - Country:US
Mailing Address - Phone:719-852-2552
Mailing Address - Fax:719-852-3742
Practice Address - Street 1:10 RUPERT ST
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1042
Practice Address - Country:US
Practice Address - Phone:719-852-2552
Practice Address - Fax:719-852-3742
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD D. SANTI, D.D.S., P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO100980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02009801Medicaid