Active NPI
Mylene Santulan, RDH, MS
- Dental Hygienist
- Fort Defiance, AZ
National Provider Identifier
1215394762
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 020008347
- Practice address
- Corner of Route N12 and N7
Fort Defiance, AZ 86504 - Phone
- (928) 729-8896
- NPI assigned
- Jan 27, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 020008347 | IL | Primary |
Addresses
Primary practice location
Corner of Route N12 and N7
Fort Defiance, AZ 86504
Mailing address
PO Box 589
Fort Defiance, AZ 86504-0589
Phone (928) 729-8896
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020008347 | IL | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453852800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453852800000",
"number": "1215394762",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 589",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "865040589",
"telephone_number": "928-729-8896"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "CORNER OF ROUTE N12 AND N7",
"city": "FORT DEFIANCE",
"state": "AZ",
"postal_code": "86504",
"telephone_number": "928-729-8896"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANTULAN",
"first_name": "MYLENE",
"credential": "RDH, MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-27",
"last_updated": "2016-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "IL",
"license": "020008347",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Defiance, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.