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General NPI Number Information
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NPI Number | 1619123437
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Entity Type | Organization
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Legal Business Name | FLORENCIO T. BURQUEZ D.D.S. INC.
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Dates
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Enumeration Date | 08/12/2008
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 2452 FENTON ST STE 102
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City | CHULA VISTA
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State | CA
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Zip | 91914-4551
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Country | US
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Telephone | 619-934-4216
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Fax | 619-621-5668
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Provider Business Mailing Address
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Address Line | 2452 FENTON ST STE 102
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City | CHULA VISTA
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State | CA
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Zip | 91914-4551
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Country | US
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Telephone | 619-934-4216
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Fax | 619-621-5668
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Authorized Official
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Title or Position | DENTIST
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Name | DR. FLORENCIO TOMAS BURQUEZ
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Credential | D.D.S.
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Telephone | 619-934-3477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 39374
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License Number State | CA
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