Provider Demographics
NPI:1558748327
Name:TORRES, RODNEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:RODNEY
Middle Name:
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 1:12026 DEACONS CROFT LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2557
Mailing Address - Country:US
Mailing Address - Phone:786-400-9011
Mailing Address - Fax:
Practice Address - Street 1:10870 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-5117
Practice Address - Country:US
Practice Address - Phone:813-920-7720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL212061223X0400X, 122300000X, 1223X0400X
KY96151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100404600Medicaid