Basic Information
Provider Information
NPI: 1003013301
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANTIAGO-DOYLE
FirstName: VALERIE
MiddleName: MARIANA
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4508 HIBISCUS VALLEY DR
Address2:  
City: AUSTIN
State: TX
PostalCode: 787391424
CountryCode: US
TelephoneNumber: 7133044605
FaxNumber:  
Practice Location
Address1: 5701 W SLAUGHTER LN
Address2: SUITE B120
City: AUSTIN
State: TX
PostalCode: 787496527
CountryCode: US
TelephoneNumber: 5124674722
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/29/2007
LastUpdateDate: 04/27/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X23399TXY Dental ProvidersDentist 

No ID Information.


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