Provider Demographics
NPI:1629199732
Name:LA TORRE, ALBERT CHARLES JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CHARLES
Last Name:LA TORRE
Suffix:JR
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 1:2289 STREET RD
Mailing Address - Street 2:
Mailing Address - City:WARRINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:18976-2338
Mailing Address - Country:US
Mailing Address - Phone:215-491-0502
Mailing Address - Fax:215-695-2277
Practice Address - Street 1:2289 STREET RD
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2338
Practice Address - Country:US
Practice Address - Phone:215-491-0502
Practice Address - Fax:215-491-2277
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS024146L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA533278OtherUNITED CONCORDIA
PA010030Medicaid