MEDICARE: DR. GINA M TORRES DMD

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	1223G0001X	General Practice Dentistry	1974	PR

General Provider Information

NPI Number	:	1063554822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GINA M TORRES DMD

Provider Business Mailing Address
First Line	:	1816 AVE PONCE DE LEON
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1906
Country	:	US
Telephone Number	:	787-727-0645
Fax Number	:	787-727-0645

Provider Business Practice Location Address
First Line	:	1816 AVE PONCE DE LEON
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00909-1906
Country	:	US
Telephone Number	:	787-727-0645
Fax Number	:	787-727-0645

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	07/08/2007

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