Provider Demographics
NPI:1063554822
Name:TORRES, GINA M (DMD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:M
Last Name:TORRES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 AVE PONCE DE LEON
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00909-1906
Mailing Address - Country:US
Mailing Address - Phone:787-727-0645
Mailing Address - Fax:787-727-0645
Practice Address - Street 1:1816 AVE PONCE DE LEON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00909-1906
Practice Address - Country:US
Practice Address - Phone:787-727-0645
Practice Address - Fax:787-727-0645
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice