Healthcare Provider Details

I. General information

NPI: 1710082151
Provider Name (Legal Business Name): CLINICA DENTAL TORRES FERNANDEZ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB. SAGRADO CORAZON # 430 AVE. SAN CLAUDIO
SAN JUAN PR
00926-4222
US

IV. Provider business mailing address

URB. SAGRADO CORAZON # 430 AVE. SAN CLAUDIO
SAN JUAN PR
00926-4222
US

V. Phone/Fax

Practice location:
  • Phone: 787-761-0888
  • Fax: 787-760-2195
Mailing address:
  • Phone: 787-761-0888
  • Fax: 787-760-2195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1249
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1621
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2509
License Number StatePR

VIII. Authorized Official

Name: DR. GILBERTO TORRES
Title or Position: DENTIST OWNER
Credential: DMD
Phone: 787-615-1932