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General NPI Number Information
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NPI Number | 1235323627
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Entity Type | Individual
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Provider Name | DR. YSIDORA TORREALBA
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Gender | Female
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Dates
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Enumeration Date | 08/29/2007
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Last Update Date | 08/29/2007
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Provider Practice Location Address
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Address Line | 305 W 12TH AVE STANLEY G. VERMILYEA, DMD, MS, DENTAL FACULTY PRACTICE
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City | COLUMBUS
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State | OH
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Zip | 43210
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Country | US
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Telephone | 614-292-1472
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Fax |
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Provider Business Mailing Address
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Address Line | 1591 ROYAL GOLD DR
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City | COLUMBUS
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State | OH
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Zip | 43240-4001
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Country | US
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Telephone | 614-247-4688
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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 | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 71-000199
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License Number State | OH
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