MEDICARE: DR. GARY L TORRES D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN 0001172	FL

General Provider Information

NPI Number	:	1023134848
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L TORRES D.M.D.

Provider Business Mailing Address
First Line	:	2185 CHENEY HWY
Second Line	:	SUITE B
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-6700
Country	:	US
Telephone Number	:	321-267-9947
Fax Number	:	321-267-3848

Provider Business Practice Location Address
First Line	:	2185 CHENEY HWY
Second Line	:	SUITE B
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-6700
Country	:	US
Telephone Number	:	321-267-9947
Fax Number	:	321-267-3848

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	07/08/2007

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