MEDICARE: DR. JUAN CARLOS FLORES DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN122722	GA

General Provider Information

NPI Number	:	1033841796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUAN CARLOS FLORES DMD

Provider Business Mailing Address
First Line	:	2530 AMBERBROOK LN
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017-1827
Country	:	US
Telephone Number	:	678-779-3077
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 LANGLEY DR STE D
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-6909
Country	:	US
Telephone Number	:	678-779-3077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2022
Last Update Date	:	06/29/2022

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