MEDICARE: DR. RALPH FLORES DDS PA

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	1223P0221X	Pediatric Dentistry	11013	TX

General Provider Information

NPI Number	:	1588768089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH FLORES DDS PA

Provider Business Mailing Address
First Line	:	5500 WALZEM
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218
Country	:	US
Telephone Number	:	210-657-4641
Fax Number	:	210-655-4012

Provider Business Practice Location Address
First Line	:	5500 WALZEM
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78218
Country	:	US
Telephone Number	:	210-657-4641
Fax Number	:	210-655-4012

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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