MEDICARE: DR. VENANCIO TORRES III D.D.S.

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	2901021518	MI

General Provider Information

NPI Number	:	1235582750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VENANCIO TORRES III D.D.S.

Provider Business Mailing Address
First Line	:	201 N RIVERSIDE AVE STE E2A
Second Line	:
City	:	SAINT CLAIR
State	:	MI
Zip	:	48079-5491
Country	:	US
Telephone Number	:	810-329-2289
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 N RIVERSIDE AVE STE E2A
Second Line	:
City	:	SAINT CLAIR
State	:	MI
Zip	:	48079-5491
Country	:	US
Telephone Number	:	810-329-2289
Fax Number	:

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

Provider Enumeration Date	:	07/20/2016
Last Update Date	:	11/27/2019

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