Provider Demographics
NPI:1487762381
Name:TORRES, NELLITA MARIA (DDS)
Entity type:Individual
Prefix:
First Name:NELLITA
Middle Name:MARIA
Last Name:TORRES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NELLITA
Other - Middle Name:M
Other - Last Name:LUDINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:288 LAFAYETTE ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801
Mailing Address - Country:US
Mailing Address - Phone:603-431-4559
Mailing Address - Fax:603-431-7560
Practice Address - Street 1:288 LAFAYETTE ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801
Practice Address - Country:US
Practice Address - Phone:603-431-4559
Practice Address - Fax:603-431-7560
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH23801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010387Medicaid
0200306Y0NH02OtherANTHEM BLUE CROSS BLUE SH