Healthcare Provider Details

I. General information

NPI: 1568506509
Provider Name (Legal Business Name): ELA M. TORRES-MOORE, D.M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE K SE STE 4
WINTER HAVEN FL
33880-4000
US

IV. Provider business mailing address

6702 HAYTER DR
LAKELAND FL
33813-3535
US

V. Phone/Fax

Practice location:
  • Phone: 863-294-4484
  • Fax:
Mailing address:
  • Phone: 863-669-5046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN14673
License Number StateFL

VIII. Authorized Official

Name: DR. ELA MARIA TORRES-MOORE
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 863-669-5046