Provider Demographics
NPI:1518944099
Name:TORRES-VAZQUEZ, PABLO OSVALDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:OSVALDO
Last Name:TORRES-VAZQUEZ
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 1:2721 N CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2547
Mailing Address - Country:US
Mailing Address - Phone:312-451-4244
Mailing Address - Fax:
Practice Address - Street 1:2721 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2547
Practice Address - Country:US
Practice Address - Phone:312-451-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0033241223G0001X
IL0190220321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice