Healthcare Provider Details

I. General information

NPI: 1205822723
Provider Name (Legal Business Name): EDGARDO J. TORO-QUINONES DMD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: EDGARDO J. TORO

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 W HILLSBOROUGH AVE
TAMPA FL
33614-6053
US

IV. Provider business mailing address

7657 SW 57TH LN APT 256
GAINESVILLE FL
32608-4985
US

V. Phone/Fax

Practice location:
  • Phone: 803-365-3021
  • Fax:
Mailing address:
  • Phone: 787-605-9013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2705
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN 18437
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN 18437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: