Healthcare Provider Details

I. General information

NPI: 1750243119
Provider Name (Legal Business Name): AURORA G FLORES BUSTAMANTE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA CARLOS G CALLES 5 Y 6 #505
SAN LUIS RIO COLORADO SONORA
83449
MX

IV. Provider business mailing address

PO BOX 15197
SAN LUIS AZ
85349-6940
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 928-509-1279
  • Fax: 928-361-2599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7590988
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: