MEDICARE: DR. MARIELENA TORRES-RICART DDS

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	1223P0221X	Pediatric Dentistry	26456	TX

General Provider Information

NPI Number	:	1922391861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIELENA TORRES-RICART DDS

Provider Business Mailing Address
First Line	:	20711 WILDERNESS OAK STE 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2641
Country	:	US
Telephone Number	:	210-787-1200
Fax Number	:	210-497-6077

Provider Business Practice Location Address
First Line	:	20711 WILDERNESS OAK STE 103
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2641
Country	:	US
Telephone Number	:	210-787-1200
Fax Number	:	210-497-6077

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

Provider Enumeration Date	:	05/25/2011
Last Update Date	:	05/24/2021

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