Provider Demographics
NPI:1255727715
Name:DE LA TORRE, NIDYA (DDS)
Entity type:Individual
Prefix:
First Name:NIDYA
Middle Name:
Last Name:DE LA TORRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NIDYA
Other - Middle Name:OLIVEROS
Other - Last Name:DE LA TORRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:20280 MARKET ST
Mailing Address - Street 2:ESHR- ATLANTIC COMMUNITY HEALTH CENTER
Mailing Address - City:ONANCOCK
Mailing Address - State:VA
Mailing Address - Zip Code:23417-1331
Mailing Address - Country:US
Mailing Address - Phone:757-414-0400
Mailing Address - Fax:757-414-0179
Practice Address - Street 1:24501 PARKSLEY ROAD
Practice Address - Street 2:
Practice Address - City:PARKSLEY
Practice Address - State:VA
Practice Address - Zip Code:23421
Practice Address - Country:US
Practice Address - Phone:757-414-0400
Practice Address - Fax:757-414-0179
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413959122300000X
MO015781122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist