Provider Demographics
NPI:1619123437
Name:FLORENCIO T. BURQUEZ D.D.S. INC.
Entity Type:Organization
Organization Name:FLORENCIO T. BURQUEZ D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FLORENCIO
Authorized Official - Middle Name:TOMAS
Authorized Official - Last Name:BURQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-934-3477
Mailing Address - Street 1:2452 FENTON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4551
Mailing Address - Country:US
Mailing Address - Phone:619-934-4216
Mailing Address - Fax:619-621-5668
Practice Address - Street 1:2452 FENTON ST STE 102
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4551
Practice Address - Country:US
Practice Address - Phone:619-934-4216
Practice Address - Fax:619-621-5668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA393741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty