Provider Demographics
NPI:1932274982
Name:FLORO, BRIAN EDSEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDSEL
Last Name:FLORO
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 1:11701-32 SAN JOSE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223
Mailing Address - Country:US
Mailing Address - Phone:904-268-0830
Mailing Address - Fax:904-268-0079
Practice Address - Street 1:11701-32 SAN JOSE BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223
Practice Address - Country:US
Practice Address - Phone:904-268-0830
Practice Address - Fax:904-268-0079
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN163341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice