Provider Demographics
NPI:1447276779
Name:SANTIAGO, PEDRO E (DMD)
Entity type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:E
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 ERWIN RD
Mailing Address - Street 2:DUKE UNIVERSITY MEDICAL CENTER, DUMC 3974
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3941
Mailing Address - Country:US
Mailing Address - Phone:919-660-0312
Mailing Address - Fax:919-660-0321
Practice Address - Street 1:3475 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-0005
Practice Address - Country:US
Practice Address - Phone:919-660-0312
Practice Address - Fax:919-660-0321
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17871223X0400X
NC86011223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics