Provider Demographics
NPI:1013926377
Name:TORRES, OMAYRA (DMD)
Entity Type:Individual
Prefix:
First Name:OMAYRA
Middle Name:
Last Name:TORRES
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 1:7700 LAKE WILSON RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-9601
Mailing Address - Country:US
Mailing Address - Phone:863-420-3166
Mailing Address - Fax:863-420-3866
Practice Address - Street 1:7700 LAKE WILSON ROAD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897
Practice Address - Country:US
Practice Address - Phone:863-420-3166
Practice Address - Fax:863-420-3866
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25791223G0001X
FL177091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice