=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164423224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ATILANO LEON-TORRES DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2005
-----------------------------------------------------
Last Update Date | 02/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 521 CALLE VALCARCEL CORNER 181 SOUTH ST
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00923-3337
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-755-4347
-----------------------------------------------------
Fax | 787-250-8450
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 29736
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00929-0736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-755-4347
-----------------------------------------------------
Fax | 787-520-7288
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 00840
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------