Provider Demographics
NPI:1942372719
Name:DANIEL M TORRES-BAYONA
Entity Type:Organization
Organization Name:DANIEL M TORRES-BAYONA
Other - Org Name:COASTAL ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:TORRES BAYONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-993-2288
Mailing Address - Street 1:6500 SOUTH PADRE ISLAND DRIVE
Mailing Address - Street 2:SUITE 25
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4055
Mailing Address - Country:US
Mailing Address - Phone:361-993-2288
Mailing Address - Fax:361-993-1199
Practice Address - Street 1:6500 SOUTH PADRE ISLAND DRIVE
Practice Address - Street 2:SUITE 25
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4055
Practice Address - Country:US
Practice Address - Phone:361-993-2288
Practice Address - Fax:361-993-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223X0400X
TX18420261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
413923OtherUNITED CONCORDIA
TX009869101Medicaid