Healthcare Provider Details

I. General information

NPI: 1225022577
Provider Name (Legal Business Name): CONNIE MERCED TORRES-RODRIGUEZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CALLE COMERCIO
RINCON PR
00677-2203
US

IV. Provider business mailing address

PO BOX 66
RINCON PR
00677-0066
US

V. Phone/Fax

Practice location:
  • Phone: 787-823-1329
  • Fax:
Mailing address:
  • Phone: 787-823-1329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2355
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: