=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295896090
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ORLANDO R TORRES DMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 02/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1645 E HWY 50 STE 100
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-5199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-242-6222
-----------------------------------------------------
Fax | 352-242-0765
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 171 BLACKSTONE CREEK ROAD
-----------------------------------------------------
City | GROVELAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34736
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-595-8644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN12804
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------