Healthcare Provider Details

I. General information

NPI: 1386525798
Provider Name (Legal Business Name): ECUADENTAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 ARLINGTON RD
JACKSONVILLE FL
32211-5411
US

IV. Provider business mailing address

6416 ARLINGTON RD
JACKSONVILLE FL
32211-5411
US

V. Phone/Fax

Practice location:
  • Phone: 904-701-3883
  • Fax: 904-618-2808
Mailing address:
  • Phone: 904-701-3883
  • Fax: 904-618-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ELSSY LOPEZ
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 904-803-8777