Provider Demographics
NPI:1518944099
Name:TORRES-VAZQUEZ, PABLO OSVALDO (DDS)
Entity type:Individual
Prefix:
First Name:PABLO
Middle Name:OSVALDO
Last Name:TORRES-VAZQUEZ
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 1:800 CARR 987 APT 1411
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738-5323
Mailing Address - Country:US
Mailing Address - Phone:312-451-4244
Mailing Address - Fax:
Practice Address - Street 1:A50 CALLE H
Practice Address - Street 2:
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-3348
Practice Address - Country:US
Practice Address - Phone:312-451-4244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190220321223G0001X
PR33241223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice