Healthcare Provider Details

I. General information

NPI: 1356279582
Provider Name (Legal Business Name): EAST DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LA TORRE
SAN JUAN PR
00925-2921
US

IV. Provider business mailing address

1075 CALLE ALONSO DE OJEDA
TOA ALTA PR
00953-5215
US

V. Phone/Fax

Practice location:
  • Phone: 787-764-2300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERNESTO ALEJANDRO SEPULVEDA TORRES
Title or Position: DENTIST
Credential: DMD
Phone: 787-234-7982