MEDICARE: CARLOS R. TORRES DDS. INC.

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	36639	CA

General Provider Information

NPI Number	:	1134313505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS R. TORRES DDS. INC.

Provider Business Mailing Address
First Line	:	1223 FRESNO ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-3218
Country	:	US
Telephone Number	:	559-445-9840
Fax Number	:	559-445-9628

Provider Business Practice Location Address
First Line	:	1223 FRESNO ST
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93706-3218
Country	:	US
Telephone Number	:	559-445-9840
Fax Number	:	559-445-9628

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CARLOS RAMON TORRES
Credential	:	DDS
Telephone Number	:	559-445-9840

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	08/29/2007

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