Provider Demographics
NPI:1629372669
Name:FLORES, LIEZL (DDS)
Entity Type:Individual
Prefix:
First Name:LIEZL
Middle Name:
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 1:1233 N VERMONT AVE
Mailing Address - Street 2:SUITE #5
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-1749
Mailing Address - Country:US
Mailing Address - Phone:323-953-9471
Mailing Address - Fax:323-953-9785
Practice Address - Street 1:1233 N VERMONT AVE
Practice Address - Street 2:SUITE #5
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1749
Practice Address - Country:US
Practice Address - Phone:323-953-9471
Practice Address - Fax:323-953-9785
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA600431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice