Healthcare Provider Details

I. General information

NPI: 1467194126
Provider Name (Legal Business Name): MARIA T TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N BEACH ST STE 100
FORT WORTH TX
76111-7070
US

IV. Provider business mailing address

400 N BEACH ST STE 100
FORT WORTH TX
76111-7070
US

V. Phone/Fax

Practice location:
  • Phone: 817-916-5244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number15283
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: