Provider Demographics
NPI:1861592990
Name:SANTIAGO, JACIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JACIEL
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ESPIRITU SANTO FINAL COND SANTA CECILIA TORRE 2
Mailing Address - Street 2:APTO 102
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-479-4470
Mailing Address - Fax:787-703-0710
Practice Address - Street 1:AVE BAIROA
Practice Address - Street 2:AA-6
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-703-0710
Practice Address - Fax:787-703-0710
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist