Provider Demographics
NPI:1306847561
Name:FIGUEROA, EDGARDO A (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDGARDO
Middle Name:A
Last Name:FIGUEROA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. LOMA LINDA
Mailing Address - Street 2:CALLE 1 A-1
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-859-3880
Mailing Address - Fax:
Practice Address - Street 1:URB. LOMA LINDA
Practice Address - Street 2:CALLE 1 A-1
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-859-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
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PR2381Medicare UPIN
PR206869Medicare UPIN
PR4-1009Medicare UPIN
PR26359Medicare UPIN
PR4-1264Medicare UPIN