Healthcare Provider Details

I. General information

NPI: 1255472387
Provider Name (Legal Business Name): ELA MARIA TORRES-MOORE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4744 S FLORIDA AVE
LAKELAND FL
33813-2181
US

IV. Provider business mailing address

308 E. PARK ST
AUBURNDALE FL
33823
US

V. Phone/Fax

Practice location:
  • Phone: 863-644-1226
  • Fax:
Mailing address:
  • Phone: 863-967-7548
  • Fax: 863-967-7693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN14673
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN14673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: