=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982072526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICARDO FLORES DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2015
-----------------------------------------------------
Last Update Date | 03/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 470 CHADBOURNE RD STE A
-----------------------------------------------------
City | FAIRFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94534-9620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-419-8989
-----------------------------------------------------
Fax | 707-258-0606
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1141 PEAR TREE LN STE 120
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-6485
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-254-1774
-----------------------------------------------------
Fax | 707-254-1779
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 65073
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------