Provider Demographics
NPI:1801977582
Name:TORRES, LUIS ALEJANDRO (DMD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALEJANDRO
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 1:10161 N LAKE VISTA CIR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-1101
Mailing Address - Country:US
Mailing Address - Phone:954-474-4676
Mailing Address - Fax:
Practice Address - Street 1:4660 W HILLSBORO BLVD
Practice Address - Street 2:7
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-2240
Practice Address - Country:US
Practice Address - Phone:954-428-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN124181223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery