Healthcare Provider Details

I. General information

NPI: 1134120314
Provider Name (Legal Business Name): EDGAR ECHEVARRIA-STUART DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 02/18/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 SOUTH MARGINAL STREET CORNER OF 521 VALCARCEL STREET
SAN JUAN PR
00923-3337
US

IV. Provider business mailing address

PO BOX 29736
SAN JUAN PR
00929-0736
US

V. Phone/Fax

Practice location:
  • Phone: 787-755-4347
  • Fax: 787-205-7288
Mailing address:
  • Phone: 787-755-4347
  • Fax: 787-250-8450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number00913
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number00913
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: