Evan Raphael Santiago, D.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

64119 Issued in CA

Practice address

6333 Telegraph Ave
Oakland, CA 94609-1359

Phone

(510) 547-1300

NPI assigned

Jul 2, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Aug 21, 2019 through Aug 21, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Evan R Santiago DDS MSD Inc

  • Periodontics
  • Oakland, CA
  • NPI 1649044835
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1404259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1033525738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 TELEGRAPH AVE STE 101",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091359",
            "telephone_number": "510-547-1300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 TELEGRAPH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946091359",
            "telephone_number": "510-547-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTIAGO",
        "first_name": "EVAN",
        "middle_name": "RAPHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-02",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "64119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Ann Santelli, D.C.
• Anita Santi, LCSW
• Jordona Santiago-Stout
• Alexandra Santiago, MD
• Angel Santiago
• Frances Santiago
• Leslie Santiago
• Stephanie Santilena, OTR/L
• Mario Santillan-Ramirez
• Alyssa Christine Santillan

• Periodontics in Oakland, CA
• Providers in Oakland, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.