Provider Demographics
NPI:1609602846
Name:TORRES ULLOA, MARYSNEY (DMD)
Entity type:Individual
Prefix:
First Name:MARYSNEY
Middle Name:
Last Name:TORRES ULLOA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14825 SW 84TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-1586
Mailing Address - Country:US
Mailing Address - Phone:786-985-4106
Mailing Address - Fax:
Practice Address - Street 1:14050 SW 84TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4440
Practice Address - Country:US
Practice Address - Phone:305-383-9944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN29635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist