Provider Demographics
NPI:1568023265
Name:FLORES, ALICE KHIEU (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:KHIEU
Last Name:FLORES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-2100
Mailing Address - Country:US
Mailing Address - Phone:562-370-3003
Mailing Address - Fax:
Practice Address - Street 1:1321 LEMON AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-2100
Practice Address - Country:US
Practice Address - Phone:562-370-3003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103778122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist