Provider Demographics
NPI:1962524488
Name:LOPEZ-TORRES, MINTA WOOD (DMD)
Entity type:Individual
Prefix:DR
First Name:MINTA
Middle Name:WOOD
Last Name:LOPEZ-TORRES
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 1:11 W HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5451
Mailing Address - Country:US
Mailing Address - Phone:407-466-6105
Mailing Address - Fax:
Practice Address - Street 1:11 W HARVARD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5451
Practice Address - Country:US
Practice Address - Phone:407-466-6105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist