Provider Demographics
NPI:1922167386
Name:FLORES, SOBERO, AND YABAR DENTAL CORPORATION
Entity Type:Organization
Organization Name:FLORES, SOBERO, AND YABAR DENTAL CORPORATION
Other - Org Name:RANCHO DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILMER
Authorized Official - Middle Name:
Authorized Official - Last Name:YABAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-688-0046
Mailing Address - Street 1:5800 VAN BUREN BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-9032
Mailing Address - Country:US
Mailing Address - Phone:951-688-0046
Mailing Address - Fax:951-688-0057
Practice Address - Street 1:5800 VAN BUREN BLVD
Practice Address - Street 2:STE 110
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-9032
Practice Address - Country:US
Practice Address - Phone:951-688-0046
Practice Address - Fax:951-688-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA443661223G0001X
CA435091223G0001X
CA441711223G0001X
CA496491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93066-01Medicaid
CA01528540OtherUNITED CONCORDIA