Provider Demographics
NPI:1942493010
Name:LATORRE, BRENDA J (DMD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:LATORRE
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:PO BOX 1445
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00977-1445
Mailing Address - Country:US
Mailing Address - Phone:787-283-1420
Mailing Address - Fax:787-760-6652
Practice Address - Street 1:EXPRESO TRUJILLO ALTO INT CARR #850
Practice Address - Street 2:BO LAS CUEVAS TERCES PISO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-283-1420
Practice Address - Fax:787-760-6652
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist