Provider Demographics
NPI:1114912417
Name:TORRES, JERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:
Last Name:TORRES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19701
Mailing Address - Street 2:MCRD PARRIS ISLAND DENTAL CENTER
Mailing Address - City:PARRIS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29905-9701
Mailing Address - Country:US
Mailing Address - Phone:843-228-3500
Mailing Address - Fax:
Practice Address - Street 1:MCRD PARRIS ISLAND DENTAL CENTER
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:29905
Practice Address - Country:US
Practice Address - Phone:843-228-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00122481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice