Provider Demographics
NPI:1538584214
Name:TORRES BUSTILLO, ANA BELEN (DMD)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:BELEN
Last Name:TORRES BUSTILLO
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 1:13550 SW 88TH ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1654
Mailing Address - Country:US
Mailing Address - Phone:305-387-3002
Mailing Address - Fax:
Practice Address - Street 1:13550 SW 88TH ST
Practice Address - Street 2:SUITE 170
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1654
Practice Address - Country:US
Practice Address - Phone:305-387-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-04
Last Update Date:2016-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN21582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist