Provider Demographics
NPI:1710082151
Name:CLINICA DENTAL TORRES FERNANDEZ LLC
Entity Type:Organization
Organization Name:CLINICA DENTAL TORRES FERNANDEZ LLC
Other - Org Name:GRUPO DENTAL TORRES FERNANDEZ
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:787-615-1932
Mailing Address - Street 1:URB. SAGRADO CORAZON # 430 AVE. SAN CLAUDIO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4222
Mailing Address - Country:US
Mailing Address - Phone:787-761-0888
Mailing Address - Fax:787-760-2195
Practice Address - Street 1:URB. SAGRADO CORAZON # 430 AVE. SAN CLAUDIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4222
Practice Address - Country:US
Practice Address - Phone:787-761-0888
Practice Address - Fax:787-760-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
PR12491223G0001X
PR16211223G0001X
PR25091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR041771OtherCRUZ AZUL
PR660386268OtherMAPFRE
PR660386268OtherMCS
PR660386268OtherDELTA
PR40814OtherTRIPLE S
PR660386268OtherHUMANA
PR660386268OtherCIGNA