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General NPI Number Information
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NPI Number | 1255696340
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Entity Type | Organization
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Legal Business Name | PROSTO-DENTAL, PSC
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | RIO AMAZONAS VALLE VERDE BC20
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City | BAYAMON
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State | PR
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Zip | 00961
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Country | US
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Telephone | 787-795-5998
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Fax |
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Provider Business Mailing Address
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Address Line | TENIENTE CESAR GONZALEZ 568
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City | HATO REY
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State | PR
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Zip | 00918
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Country | US
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Telephone | 787-758-3804
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Fax |
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Authorized Official
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Title or Position | PROSTODONTICS
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Name | DR. CARLOS ALBERTO TORRES
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Credential | D.M.D
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Telephone | 787-758-3804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 2756
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License Number State | PR
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