Provider Demographics
NPI:1932467990
Name:EA DENTAL, P.S.C.
Entity Type:Organization
Organization Name:EA DENTAL, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTE
Authorized Official - Prefix:
Authorized Official - First Name:EDGARDO
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:ESTREMERA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-262-5757
Mailing Address - Street 1:HC 5 BOX 92970
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00612-9559
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CARR 129 KM 8.8 CAMPO ALEGRE
Practice Address - Street 2:#2
Practice Address - City:HATILLO
Practice Address - State:PR
Practice Address - Zip Code:00659-9819
Practice Address - Country:US
Practice Address - Phone:787-262-5757
Practice Address - Fax:787-262-5757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty