Healthcare Provider Details

I. General information

NPI: 1528269933
Provider Name (Legal Business Name): ANDRES JOSE TORRES D.D.S.,M.S.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 RESEDA BLVD STE 112
RESEDA CA
91335-5340
US

IV. Provider business mailing address

6650 RESEDA BLVD STE 112
RESEDA CA
91335-5340
US

V. Phone/Fax

Practice location:
  • Phone: 818-609-7525
  • Fax:
Mailing address:
  • Phone: 818-609-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number50686
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number50686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: