Basic Information
| Provider Information | |||||||||
| NPI: | 1083891261 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREGORY A. SANTARELLI DDS SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5017 GREEN BAY RD STE 138 | ||||||||
| Address2: | |||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531441782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626546770 | ||||||||
| FaxNumber: | 2626546727 | ||||||||
| Practice Location | |||||||||
| Address1: | 5017 GREEN BAY RD STE 138 | ||||||||
| Address2: | |||||||||
| City: | KENOSHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531441782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2626546770 | ||||||||
| FaxNumber: | 2626546727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2008 | ||||||||
| LastUpdateDate: | 10/05/2009 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2626546770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223S0112X | 5188015 | WI | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | Oral and Maxillofacial Surgery |
No ID Information.