Healthcare Provider Details

I. General information

NPI: 1437093309
Provider Name (Legal Business Name): ENDODONTIC CARE SPECIALTY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 CALLE JACANA
SAN JUAN PR
00926-7155
US

IV. Provider business mailing address

394 CALLE JACANA
SAN JUAN PR
00926-7155
US

V. Phone/Fax

Practice location:
  • Phone: 787-420-9979
  • Fax:
Mailing address:
  • Phone: 787-420-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL ALEJANDRO PEREA CUEBAS
Title or Position: DENTIST/ENDODONTIST
Credential: DMD
Phone: 787-420-9979