Provider Demographics
NPI:1447504535
Name:TORGERSEN, GINA (DDS)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:
Last Name:TORGERSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 MOBIL AVE
Mailing Address - Street 2:#31
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-484-1221
Mailing Address - Fax:805-389-0900
Practice Address - Street 1:484 MOBIL AVE
Practice Address - Street 2:#31
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-484-1221
Practice Address - Fax:805-389-0900
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADG036204122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist