Provider Demographics
NPI:1053355685
Name:SANTIAGO, NESTOR M (DDS)
Entity type:Individual
Prefix:DR
First Name:NESTOR
Middle Name:M
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-1015 MEAKINO ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5955
Mailing Address - Country:US
Mailing Address - Phone:808-780-4136
Mailing Address - Fax:808-935-4870
Practice Address - Street 1:C/O ISLAND OHANA DENTAL
Practice Address - Street 2:101 AUPUNI ST, PH 1014-C
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720
Practice Address - Country:US
Practice Address - Phone:808-935-4800
Practice Address - Fax:808-935-4870
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 20431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI204304OtherDELTA DENTAL
HID237380OtherHMSA
HI52089206Medicaid