Provider Demographics
NPI:1356545537
Name:GONZALEZ-TORRES, JAN P (DDS)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:P
Last Name:GONZALEZ-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 1:356 W 18TH STREET
Mailing Address - Street 2:CALLEN-LORDE CHC, DEPT OF DENTISTRY
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011
Mailing Address - Country:US
Mailing Address - Phone:212-271-7171
Mailing Address - Fax:
Practice Address - Street 1:356 W 18TH STREET
Practice Address - Street 2:CALLEN-LORDE CHC, DEPT OF DENTISTRY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011
Practice Address - Country:US
Practice Address - Phone:212-271-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053226122300000X, 1223G0001X
CA61247122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice