Healthcare Provider Details

I. General information

NPI: 1194714543
Provider Name (Legal Business Name): SALVADOR NMI FLORES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1067 TWINING DR
BARKSDALE AFB LA
71110-2486
US

IV. Provider business mailing address

52 TURNBURY DR
BOSSIER CITY LA
71111-8203
US

V. Phone/Fax

Practice location:
  • Phone: 318-456-6781
  • Fax: 318-456-6636
Mailing address:
  • Phone: 318-549-0047
  • Fax: 318-456-6636

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1-14050-9
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: