Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2901011733 | MI |
NPI | 1083686380 |
---|---|
Provider Name | John A Santoro |
First Address | Riverview, MI 48193 |
Second Address | Riverview, MI 48193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2006 |
Last Update Date | 08/07/2007 |