Provider Demographics
NPI:1609830702
Name:TORRES, IVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name: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 6026
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6026
Mailing Address - Country:US
Mailing Address - Phone:787-831-6856
Mailing Address - Fax:787-831-6856
Practice Address - Street 1:8 CONDOMINIUM AVE
Practice Address - Street 2:SUITE NO. 104
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:787-831-6856
Practice Address - Fax:787-831-6856
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice