Provider Demographics
NPI:1750453882
Name:TORRES-RODRIGUEZ, MERCEDES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:TORRES-RODRIGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W 190TH ST APT 4D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3655
Mailing Address - Country:US
Mailing Address - Phone:212-923-3662
Mailing Address - Fax:
Practice Address - Street 1:219 AUDUBON AVE APT 1B2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-8316
Practice Address - Country:US
Practice Address - Phone:212-923-3662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045187-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01477361Medicaid