Provider Demographics
NPI:1861572141
Name:COLON, SANTIAGO E (DMD)
Entity type:Individual
Prefix:DR
First Name:SANTIAGO
Middle Name:E
Last Name:COLON
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 1:2700 SW 87TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3242
Mailing Address - Country:US
Mailing Address - Phone:305-227-2535
Mailing Address - Fax:305-227-2571
Practice Address - Street 1:2700 SW 87TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3242
Practice Address - Country:US
Practice Address - Phone:305-227-2535
Practice Address - Fax:305-227-2571
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN128321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics