Healthcare Provider Details

I. General information

NPI: 1124758487
Provider Name (Legal Business Name): MANUEL ALEJANDRO PEREA CUEBAS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 CALLE JACANA
SAN JUAN PR
00926-7155
US

IV. Provider business mailing address

LOS ARBOLES DE MONTEHIEDRA JACANA 394
SAN JUAN PR
00926
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 Number3579
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3579
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: