Provider Demographics
NPI:1508424243
Name:DEL TORO, TRAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:
Last Name:DEL TORO
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 1:3940 N TRAVERSE MOUNTAIN BLVD # 102
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4914
Mailing Address - Country:US
Mailing Address - Phone:801-852-8211
Mailing Address - Fax:
Practice Address - Street 1:2525 E 30TH ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-4503
Practice Address - Country:US
Practice Address - Phone:505-327-4863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD50981223G0001X
UT11997356-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice