Provider Demographics
NPI:1619237062
Name:TORRES DENTAL SPECIALTIES PLLC
Entity Type:Organization
Organization Name:TORRES DENTAL SPECIALTIES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-240-4381
Mailing Address - Street 1:4402 WILLIAMS DR
Mailing Address - Street 2:SUITE #104
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1300
Mailing Address - Country:US
Mailing Address - Phone:512-240-4381
Mailing Address - Fax:
Practice Address - Street 1:4402 WILLIAMS DR
Practice Address - Street 2:SUITE #104
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1300
Practice Address - Country:US
Practice Address - Phone:512-240-4381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-19
Last Update Date:2012-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166081223E0200X
TX166091223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty