MEDICARE: MARIA T TORRES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	15283	TX

General Provider Information

NPI Number	:	1467194126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA T TORRES

Provider Business Mailing Address
First Line	:	400 N BEACH ST STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-7070
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 N BEACH ST STE 100
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76111-7070
Country	:	US
Telephone Number	:	817-916-5244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2022
Last Update Date	:	04/12/2022

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