Provider Demographics
NPI:1164423224
Name:LEON-TORRES, ATILANO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ATILANO
Middle Name:
Last Name:LEON-TORRES
Suffix:
Gender:M
Credentials:DMD
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 29736
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0736
Mailing Address - Country:US
Mailing Address - Phone:787-755-4347
Mailing Address - Fax:787-250-8450
Practice Address - Street 1:521 CALLE VALCARCEL
Practice Address - Street 2:CORNER 181 SOUTH ST
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923-3337
Practice Address - Country:US
Practice Address - Phone:787-755-4347
Practice Address - Fax:787-250-8450
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008401223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR9200081OtherHUMANA
PR4-0889OtherMEDICARE
PR1900366OtherACAA
PR4-0889OtherTRIPLE-S, INC.
PR4-0889OtherTRIPLE-S, INC.