Individual provider Active NPI

Angela Xaviera Torres, DMD

  • Dentist
  • Jemez Pueblo, NM
National Provider Identifier
1750615506
Registry record updated Mar 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DD3253 Issued in NM
Practice address
110 Sheep Springs Rd
Jemez Pueblo, NM 87024
Phone
(575) 834-7413
Fax
(575) 834-3080
NPI assigned
Sep 28, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DD3253 NM Primary

Addresses

Primary practice location

110 Sheep Springs Rd
Jemez Pueblo, NM 87024

Mailing address

110 Sheep Springs Rd
Jemez Pueblo, NM 87024-0279

Other identifiers 1

IdentifierTypeStateIssuer
83508821MedicaidNM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210106002365 TX Practitioner - Dentist 7517370760 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kewa Pueblo Health Corporation CurrentSince Dec 28, 2020 Accepting new patients
Kewa Pueblo Health Corporation Past Accepting new patients

Locations

85 W Highway 22
Santo Domingo Pueblo, NM 87052
Phone (505) 465-3060

Interoperability endpoints

  • Direct secure messaging: angela.torres.p1@direct.kp-hc.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1254096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394409600000",
    "number": "1750615506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 SHEEP SPRINGS RD",
            "city": "JEMEZ PUEBLO",
            "state": "NM",
            "postal_code": "870240279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 SHEEP SPRINGS RD",
            "city": "JEMEZ PUEBLO",
            "state": "NM",
            "postal_code": "87024",
            "telephone_number": "575-834-7413",
            "fax_number": "575-834-3080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TORRES",
        "first_name": "ANGELA",
        "middle_name": "XAVIERA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-28",
        "last_updated": "2014-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD3253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "83508821",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jemez Pueblo, NM

Sources for this page

Verify at the official NPI Registry.