Provider Demographics
NPI:1164572780
Name:SEPULVEDA, ERIC M (DMD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:M
Last Name:SEPULVEDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB PARK SIDE
Mailing Address - Street 2:B 15 CALLE 2
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-793-7040
Mailing Address - Fax:787-783-0885
Practice Address - Street 1:URB PARK SIDE
Practice Address - Street 2:B 15 CALLE 2
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-793-7040
Practice Address - Fax:787-783-0885
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice