Provider Demographics
NPI:1144306259
Name:SANTAELLA, DIMAS ALEJANDRO (DMD PEDIATRIC)
Entity type:Individual
Prefix:DR
First Name:DIMAS
Middle Name:ALEJANDRO
Last Name:SANTAELLA
Suffix:
Gender:M
Credentials:DMD PEDIATRIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CALLE MENDEZ VIGO E
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4934
Mailing Address - Country:US
Mailing Address - Phone:787-265-2265
Mailing Address - Fax:787-834-2229
Practice Address - Street 1:61 CALLE MENDEZ VIGO E
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4934
Practice Address - Country:US
Practice Address - Phone:787-265-2265
Practice Address - Fax:787-834-2229
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry