MEDICARE: EDGARDO J. TORO-QUINONES DMD, PHD

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN 18437	FL
2	1223P0221X	Pediatric Dentistry	DN 18437	FL
3	1223P0221X	Pediatric Dentistry	2705	PR

General Provider Information

NPI Number	:	1205822723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGARDO J. TORO-QUINONES DMD, PHD

Provider Business Mailing Address
First Line	:	7657 SW 57TH LN APT 256
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32608-4985
Country	:	US
Telephone Number	:	787-605-9013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 W HILLSBOROUGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-6053
Country	:	US
Telephone Number	:	803-365-3021
Fax Number	:

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	06/20/2014

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