Provider Demographics
NPI:1548728322
Name:CALO DE LA TORRE, STEPHANIE AILEEN (DMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:AILEEN
Last Name:CALO DE LA TORRE
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 CONECTOR C APT 232
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-2271
Mailing Address - Country:US
Mailing Address - Phone:787-462-2700
Mailing Address - Fax:
Practice Address - Street 1:URB. ALTAMESA
Practice Address - Street 2:AVE. SAN ALFONSO 1324
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-767-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-11
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR33691223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice