MEDICARE: DR. DREXY PEARL TORRES ANCOG DDS

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	7743	OK

General Provider Information

NPI Number	:	1346939253
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DREXY PEARL TORRES ANCOG DDS

Provider Business Mailing Address
First Line	:	13208 SAWTOOTH OAK RD
Second Line	:
City	:	CHOCTAW
State	:	OK
Zip	:	73020-2156
Country	:	US
Telephone Number	:	405-248-7026
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 NE 36TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-5002
Country	:	US
Telephone Number	:	405-967-7742
Fax Number	:

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

Provider Enumeration Date	:	05/05/2023
Last Update Date	:	08/23/2024

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