Provider Demographics
NPI:1114949542
Name:FLORES, JESUS A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:A
Last Name:FLORES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 W REDLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8023
Mailing Address - Country:US
Mailing Address - Phone:909-792-0071
Mailing Address - Fax:909-307-8310
Practice Address - Street 1:1585 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8023
Practice Address - Country:US
Practice Address - Phone:909-792-0071
Practice Address - Fax:909-307-8310
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice