Healthcare Provider Details

I. General information

NPI: 1639499486
Provider Name (Legal Business Name): GUILLERMO ISAAC TORRES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S BROADWAY SUITE 208
TARRYTOWN NY
10591-4500
US

IV. Provider business mailing address

200 S BROADWAY SUITE 208
TARRYTOWN NY
10591-4500
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-2323
  • Fax: 914-631-1639
Mailing address:
  • Phone: 914-631-2323
  • Fax: 914-631-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number046758
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number046758
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: