Provider Demographics
NPI:1346388436
Name:FLORES, JESSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
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 1:5370 SCHAEFER AVE STE C
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-9008
Mailing Address - Country:US
Mailing Address - Phone:909-548-3300
Mailing Address - Fax:909-548-3290
Practice Address - Street 1:5370 SCHAEFER AVE STE C
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-9008
Practice Address - Country:US
Practice Address - Phone:909-548-3300
Practice Address - Fax:909-548-3290
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA392601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice