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General NPI Number Information
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NPI Number | 1326345497
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Entity Type | Organization
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Legal Business Name | JORGE A. FLORES DDS, INC.
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Dates
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Enumeration Date | 02/25/2011
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Last Update Date | 02/25/2011
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Provider Practice Location Address
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Address Line | 249 W FOOTHILL BLVD
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City | RIALTO
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State | CA
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Zip | 92376-5047
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Country | US
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Telephone | 909-820-2420
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Fax | 909-820-2490
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Provider Business Mailing Address
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Address Line | 249 W FOOTHILL BLVD
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City | RIALTO
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State | CA
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Zip | 92376-5047
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Country | US
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Telephone | 909-820-2420
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Fax | 909-820-2490
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. JORGE ALFREDO FLORES
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Credential | DDS
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Telephone | 909-820-2420
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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 | 49313
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License Number State | CA
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