Provider Demographics
NPI:1912153917
Name:FLORES, ROBERT (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 BOYSEN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1311
Mailing Address - Country:US
Mailing Address - Phone:805-544-9440
Mailing Address - Fax:805-544-9458
Practice Address - Street 1:878 BOYSEN AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1311
Practice Address - Country:US
Practice Address - Phone:805-544-9440
Practice Address - Fax:805-544-9458
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57573122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist