Provider Demographics
NPI:1609056845
Name:SANTANA, TOMASA AMELIA (DDS)
Entity type:Individual
Prefix:DR
First Name:TOMASA
Middle Name:AMELIA
Last Name:SANTANA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 GROVE ST
Mailing Address - Street 2:APT. II
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4668
Mailing Address - Country:US
Mailing Address - Phone:201-860-8764
Mailing Address - Fax:
Practice Address - Street 1:520 CLIFTON AVE
Practice Address - Street 2:4
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-3247
Practice Address - Country:US
Practice Address - Phone:973-772-4222
Practice Address - Fax:973-772-7652
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02355400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist