MEDICARE: MARIBEL COLON-TORRADO DMD, PA

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	261QD0000X	Dental Clinic/Center	21532	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912060138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIBEL COLON-TORRADO DMD, PA

Provider Business Mailing Address
First Line	:	2815 W LAKE HOUSTON PKWY STE 105
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-5220
Country	:	US
Telephone Number	:	281-446-1169
Fax Number	:

Provider Business Practice Location Address
First Line	:	2815 W LAKE HOUSTON PKWY
Second Line	:	SUITE 105
City	:	KINGWOOD
State	:	TX
Zip	:	77339-5227
Country	:	US
Telephone Number	:	281-446-1169
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIBEL COLON-TORRADO
Credential	:	DMD
Telephone Number	:	713-503-9073

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	01/18/2017

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