Provider Demographics
NPI:1700159266
Name:FLORES, JORGE A (DDS)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:A
Last Name:FLORES
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:PO BOX 2242
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78044-2242
Mailing Address - Country:US
Mailing Address - Phone:956-740-9444
Mailing Address - Fax:
Practice Address - Street 1:2840 MORELOS
Practice Address - Street 2:
Practice Address - City:NUEVO LAREDO
Practice Address - State:TAMAULIPAS
Practice Address - Zip Code:88000
Practice Address - Country:MX
Practice Address - Phone:956-740-9444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ1403391122300000X
ZZAE-0080821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics