Provider Demographics
NPI:1417019068
Name:TORBECK, ELLEN C (DMD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:C
Last Name:TORBECK
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 425
Mailing Address - Street 2:2618 BURLINGTON PIKE
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005
Mailing Address - Country:US
Mailing Address - Phone:859-586-7900
Mailing Address - Fax:859-586-7931
Practice Address - Street 1:2618 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005
Practice Address - Country:US
Practice Address - Phone:859-586-7900
Practice Address - Fax:859-586-7931
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist