Healthcare Provider Details

I. General information

NPI: 1215970637
Provider Name (Legal Business Name): SUSANA E TORRES D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUSANA E. RAMIREZ

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 W OGDEN AVE
CHICAGO IL
60623-2460
US

IV. Provider business mailing address

9119 S EXCHANGE AVE
CHICAGO IL
60617-4225
US

V. Phone/Fax

Practice location:
  • Phone: 773-843-3000
  • Fax: 773-542-6029
Mailing address:
  • Phone: 773-768-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019-025928
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: