Provider Demographics
NPI:1942411962
Name:TORRES, LEONEL (DDS,MAGD)
Entity Type:Individual
Prefix:
First Name:LEONEL
Middle Name:
Last Name:TORRES
Suffix:
Gender:M
Credentials:DDS,MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 S WOODLAND BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7464
Mailing Address - Country:US
Mailing Address - Phone:862-026-0253
Mailing Address - Fax:386-202-1755
Practice Address - Street 1:1205 S WOODLAND BLVD STE 5
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7464
Practice Address - Country:US
Practice Address - Phone:386-888-4911
Practice Address - Fax:386-269-9951
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009838000Medicaid