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General NPI Number Information
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NPI Number | 1174045454
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Entity Type | Individual
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Provider Name | MARIA CONSTANZA TORRES IBACACHE DDS
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Gender | Female
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Dates
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Enumeration Date | 07/08/2017
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 1 KNEELAND ST FL 2
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City | BOSTON
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State | MA
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Zip | 02111-1527
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Country | US
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Telephone | 617-636-6828
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CANAL ST UNIT 535
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City | BOSTON
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State | MA
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Zip | 02114-2027
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Country | US
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Telephone | 857-389-5778
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DF11579
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DF11761
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License Number State | MA
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