Provider Demographics
NPI:1811937915
Name:TORRES, GLORIA TIJERINA (DDS)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:TIJERINA
Last Name:TORRES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:LETICIA
Other - Last Name:TIJERINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4402 WILLIAMS DRIVE
Mailing Address - Street 2:SUITE # 104
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628
Mailing Address - Country:US
Mailing Address - Phone:512-240-4381
Mailing Address - Fax:
Practice Address - Street 1:4402 WILLIAMS DRIVE
Practice Address - Street 2:SUITE # 104
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628
Practice Address - Country:US
Practice Address - Phone:512-240-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166091223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics