Healthcare Provider Details

I. General information

NPI: 1720318439
Provider Name (Legal Business Name): JASON FLORES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 CAMINO DE SALUD NE
ALBUQUERQUE NM
87102-4516
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-925-7767
  • Fax:
Mailing address:
  • Phone: 505-272-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number24741
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License NumberDD3741
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number24741
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3741
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: