Healthcare Provider Details

I. General information

NPI: 1518944099
Provider Name (Legal Business Name): PABLO OSVALDO TORRES-VAZQUEZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A50 CALLE H
FAJARDO PR
00738-3348
US

IV. Provider business mailing address

800 CARR 987 APT 1411
FAJARDO PR
00738-5323
US

V. Phone/Fax

Practice location:
  • Phone: 312-451-4244
  • Fax:
Mailing address:
  • Phone: 312-451-4244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019022032
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3324
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3324
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: