Healthcare Provider Details

I. General information

NPI: 1326034067
Provider Name (Legal Business Name): EDGARDO JAVIER ALEGRIA MS, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 12/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JOSE JULIAN ACOSTA STREET SUITE 41
VEGA BAJA PR
00693
US

IV. Provider business mailing address

PO BOX 4121
VEGA BAJA PR
00694-4121
US

V. Phone/Fax

Practice location:
  • Phone: 787-855-6161
  • Fax: 787-855-9475
Mailing address:
  • Phone: 787-855-6161
  • Fax: 787-855-9475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1595
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: