Individual
JESUS ANTONIO SANTIAGO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
370 TALBERT RD, STE 300, MOORESVILLE, NC 28117
(954) 494-2103
Mailing address
525 E 21ST ST APT 105, CHARLOTTE, NC 28206-3880
(954) 494-2103
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13946
NC
Other
Enumeration date
04/11/2024
Last updated
08/26/2024
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