Healthcare Provider Details

I. General information

NPI: 1861125692
Provider Name (Legal Business Name): QUIESLY MARIA TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 7TH AVE S # SDB315
BIRMINGHAM AL
35233-2005
US

IV. Provider business mailing address

1919 7TH AVE SOUTH
BIRMINGHAM AL
35294-0007
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-0046
  • Fax:
Mailing address:
  • Phone: 205-934-0054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401419678
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number390200000X
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: