Provider Demographics
NPI:1508207200
Name:TORRES AND SANDOVAL FAMILY DENTAL PLLC
Entity Type:Organization
Organization Name:TORRES AND SANDOVAL FAMILY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRMA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:718-584-9777
Mailing Address - Street 1:3201 GRAND CONCOURSE
Mailing Address - Street 2:2K
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1247
Mailing Address - Country:US
Mailing Address - Phone:718-584-9777
Mailing Address - Fax:
Practice Address - Street 1:3201 GRAND CONCOURSE
Practice Address - Street 2:2K
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1247
Practice Address - Country:US
Practice Address - Phone:718-584-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02620226Medicaid