Renzo Santisteban, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12996 Issued in NC

Practice address

460 SW Center St
Faison, NC 28341-8820

Phone

(910) 267-0951

Fax

(910) 718-9334

NPI assigned

May 13, 2022

Last updated

Jul 26, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Goshen Medical Center, Incorporated

  dba Goshen Medical Center - Duplin

  • Federally Qualified Health Center (FQHC)
  • Kenansville, NC
  • NPI 1962124974
  Medicare reassignment NPD
• Goshen Medical Center Incorporated

  dba Rosewood Dental Services

  • Dental Clinic/Center
  • Goldsboro, NC
  • NPI 1326443870
  NPD
• Goshen Medical Center Incorporated

  dba GMC Pharmacy at Rockingham

  • Federally Qualified Health Center (FQHC)
  • Rockingham, NC
  • NPI 1457181323
  NPD
• New Hanover Community Health Center Incorporated

  dba MedNorth Health Center

  • Federally Qualified Health Center (FQHC)
  • Wilmington, NC
  • NPI 1912954090
  NPD (past)
• New Hanover Community Health Center, Inc.

  • General Practice Dentistry
  • Wilmington, NC
  • NPI 1851507214
  NPD (past)

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

{
    "created_epoch": "1652400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721952000000",
    "number": "1396482295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 187",
            "city": "FAISON",
            "state": "NC",
            "postal_code": "283410187",
            "telephone_number": "910-267-2042",
            "fax_number": "855-996-9090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 SW CENTER ST",
            "city": "FAISON",
            "state": "NC",
            "postal_code": "283418820",
            "telephone_number": "910-267-0951",
            "fax_number": "910-718-9334"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "925 N 4th St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284013450",
            "country_code": "US",
            "telephone_number": "910-343-0270",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANTISTEBAN",
        "first_name": "RENZO",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-13",
        "last_updated": "2024-07-26",
        "certification_date": "2024-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "12996",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Ralph Page, M.D.
• Keith Patti, PHARM
• Alice Petersen, MSN, FNP-C, CCRA
• Julissa Quintanilla, PA-C
• Randall Richards, M.D.
• Walter R Schmits Jr., M.D.
• Katheryn M Sican, PA-C
• Sharon R Smith, FNP
• Jenny Anna Turek, DDS

• General Practice Dentistry in Faison, NC
• Providers in Faison, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.