Provider Demographics
NPI:1659806719
Name:FLORES DUBON, MACKLIN ALBERTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MACKLIN
Middle Name:ALBERTO
Last Name:FLORES DUBON
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 1:221 DAWSON CT
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-3664
Mailing Address - Country:US
Mailing Address - Phone:650-201-8049
Mailing Address - Fax:
Practice Address - Street 1:221 DAWSON CT
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-3664
Practice Address - Country:US
Practice Address - Phone:650-201-8049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101293122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist