Provider Demographics
NPI:1992132278
Name:VICTORES, NORMA (DMD)
Entity type:Individual
Prefix:DR
First Name:NORMA
Middle Name:
Last Name:VICTORES
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 1:285 W 49TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3713
Mailing Address - Country:US
Mailing Address - Phone:305-558-7161
Mailing Address - Fax:305-558-9593
Practice Address - Street 1:285 W 49TH ST STE A
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3713
Practice Address - Country:US
Practice Address - Phone:305-558-7161
Practice Address - Fax:305-558-9593
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0712493Medicaid