Provider Demographics
NPI:1821724261
Name:FLORES, MIRNA ELENA (DMD)
Entity Type:Individual
Prefix:
First Name:MIRNA
Middle Name:ELENA
Last Name:FLORES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15317 W BELL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3901
Mailing Address - Country:US
Mailing Address - Phone:877-809-5092
Mailing Address - Fax:623-214-5231
Practice Address - Street 1:15317 W BELL RD STE 108
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3901
Practice Address - Country:US
Practice Address - Phone:877-809-5092
Practice Address - Fax:623-214-5231
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011455122300000X, 1223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice