Provider Demographics
NPI:1134120314
Name:ECHEVARRIA-STUART, EDGAR (DMD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:ECHEVARRIA-STUART
Suffix:
Gender:
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:PO BOX 29736
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0736
Mailing Address - Country:US
Mailing Address - Phone:787-755-4347
Mailing Address - Fax:787-250-8450
Practice Address - Street 1:181 SOUTH MARGINAL STREET
Practice Address - Street 2:CORNER OF 521 VALCARCEL STREET
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3337
Practice Address - Country:US
Practice Address - Phone:787-755-4347
Practice Address - Fax:787-205-7288
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR00913204E00000X, 1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4-1164OtherTRIPLE-S, INC.
PR4-1164OtherTRIPLE-S, INC.
PR9200084OtherHUMANA
PR4-1164OtherTRIPLE-S, INC.
PRHW722AMedicare PIN
PRT-70662Medicare UPIN