Provider Demographics
NPI:1639499486
Name:TORRES, GUILLERMO ISAAC (DDS)
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:ISAAC
Last Name:TORRES
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 1:200 S BROADWAY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4500
Mailing Address - Country:US
Mailing Address - Phone:914-631-2323
Mailing Address - Fax:914-631-1639
Practice Address - Street 1:200 S BROADWAY
Practice Address - Street 2:SUITE 208
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4500
Practice Address - Country:US
Practice Address - Phone:914-631-2323
Practice Address - Fax:914-631-1639
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0467581223P0700X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist