Healthcare Provider Details

I. General information

NPI: 1386184869
Provider Name (Legal Business Name): ROBERTO ALEJANDRO TORRES DAVIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 07/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

M10 AVE EL CONQUISTADOR
FAJARDO PR
00738
US

IV. Provider business mailing address

PO BOX 7215
MAYAGUEZ PR
00681-7215
US

V. Phone/Fax

Practice location:
  • Phone: 787-860-4223
  • Fax:
Mailing address:
  • Phone: 787-458-2303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3262
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: