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General NPI Number Information
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NPI Number | 1912383845
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Entity Type | Organization
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Legal Business Name | DR FLORES FAMILY DENTAL OFFICE PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 08/03/2015
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Last Update Date | 08/03/2015
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Provider Practice Location Address
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Address Line | 1585 W REDLANDS BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-8023
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Country | US
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Telephone | 909-792-0071
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Fax | 909-307-8310
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Provider Business Mailing Address
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Address Line | 1585 W REDLANDS BLVD
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City | REDLANDS
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State | CA
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Zip | 92373-8023
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Country | US
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Telephone | 909-792-0071
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Fax | 909-307-8310
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JESUS A FLORES
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Credential | DDS
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Telephone | 909-792-0071
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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 | 37823
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License Number State | CA
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