Healthcare Provider Details

I. General information

NPI: 1285569194
Provider Name (Legal Business Name): MICHELLE DE LA TORRE RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 BELL BLVD STE LH
BAYSIDE NY
11360-2032
US

IV. Provider business mailing address

5404 69TH ST
MASPETH NY
11378-1805
US

V. Phone/Fax

Practice location:
  • Phone: 718-468-1900
  • Fax:
Mailing address:
  • Phone: 929-259-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number032839
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: