Healthcare Provider Details

I. General information

NPI: 1619237062
Provider Name (Legal Business Name): TORRES DENTAL SPECIALTIES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2012
Last Update Date: 05/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 WILLIAMS DR SUITE #104
GEORGETOWN TX
78628-1300
US

IV. Provider business mailing address

4402 WILLIAMS DR SUITE #104
GEORGETOWN TX
78628-1300
US

V. Phone/Fax

Practice location:
  • Phone: 512-240-4381
  • Fax:
Mailing address:
  • Phone: 512-240-4381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number16608
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number16609
License Number StateTX

VIII. Authorized Official

Name: DR. CRAIG PETER TORRES
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 512-240-4381