Provider Demographics
NPI:1134312861
Name:TORRES, ERNESTO I (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:I
Last Name:TORRES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 RIVERS EDGE VILLAGE LN UNIT 5402
Mailing Address - Street 2:
Mailing Address - City:PONCE INLET
Mailing Address - State:FL
Mailing Address - Zip Code:32127-2203
Mailing Address - Country:US
Mailing Address - Phone:386-760-9360
Mailing Address - Fax:386-760-9360
Practice Address - Street 1:900 N SWALLOWTAIL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6102
Practice Address - Country:US
Practice Address - Phone:386-788-5000
Practice Address - Fax:386-788-5001
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0009041122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist