Provider Demographics
NPI:1144785478
Name:FLORES, JESSICA (RDA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 N FRESNO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5282
Mailing Address - Country:US
Mailing Address - Phone:559-439-2307
Mailing Address - Fax:559-439-8319
Practice Address - Street 1:6323 N FRESNO ST STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5282
Practice Address - Country:US
Practice Address - Phone:559-439-2307
Practice Address - Fax:559-439-8319
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA90558126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant