Provider Demographics
NPI:1912383845
Name:DR FLORES FAMILY DENTAL OFFICE PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR FLORES FAMILY DENTAL OFFICE PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-792-0071
Mailing Address - Street 1:1585 W REDLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8023
Mailing Address - Country:US
Mailing Address - Phone:909-792-0071
Mailing Address - Fax:909-307-8310
Practice Address - Street 1:1585 W REDLANDS BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8023
Practice Address - Country:US
Practice Address - Phone:909-792-0071
Practice Address - Fax:909-307-8310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37823261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1114949542OtherPERSONAL NPI