Provider Demographics
NPI:1326345497
Name:JORGE A. FLORES DDS, INC.
Entity Type:Organization
Organization Name:JORGE A. FLORES DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ALFREDO
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-820-2420
Mailing Address - Street 1:249 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5047
Mailing Address - Country:US
Mailing Address - Phone:909-820-2420
Mailing Address - Fax:909-820-2490
Practice Address - Street 1:249 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5047
Practice Address - Country:US
Practice Address - Phone:909-820-2420
Practice Address - Fax:909-820-2490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-25
Last Update Date:2011-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49313261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental