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General NPI Number Information
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NPI Number | 1619237062
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Entity Type | Organization
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Legal Business Name | TORRES DENTAL SPECIALTIES PLLC
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Dates
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Enumeration Date | 05/19/2012
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Last Update Date | 05/19/2012
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Provider Practice Location Address
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Address Line | 4402 WILLIAMS DR SUITE #104
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City | GEORGETOWN
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State | TX
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Zip | 78628-1300
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Country | US
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Telephone | 512-240-4381
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Fax |
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Provider Business Mailing Address
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Address Line | 4402 WILLIAMS DR SUITE #104
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City | GEORGETOWN
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State | TX
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Zip | 78628-1300
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Country | US
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Telephone | 512-240-4381
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CRAIG PETER TORRES
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Credential | D.D.S.
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Telephone | 512-240-4381
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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 | 16609
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 16608
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License Number State | TX
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