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General NPI Number Information
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NPI Number | 1043935596
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Entity Type | Organization
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Legal Business Name | BROC FLORES, DMD, P.A
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 10/06/2022
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Provider Practice Location Address
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Address Line | 5911 TIMUQUANA RD STE 202
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City | JACKSONVILLE
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State | FL
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Zip | 32210-8174
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Country | US
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Telephone | 904-553-8114
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Fax |
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Provider Business Mailing Address
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Address Line | 1592 GLENDALE ST
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City | JACKSONVILLE
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State | FL
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Zip | 32205-8925
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Country | US
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Telephone | 904-553-8114
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BROC FLORES
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Credential | DMD
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Telephone | 904-553-8114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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