Provider Demographics
NPI:1366715807
Name:FLAMENCO, DAVID CHRISTOPHER (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CHRISTOPHER
Last Name:FLAMENCO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8860 CENTER DR STE 410
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7003
Mailing Address - Country:US
Mailing Address - Phone:619-493-2013
Mailing Address - Fax:619-493-2212
Practice Address - Street 1:8860 CENTER DR STE 410
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7003
Practice Address - Country:US
Practice Address - Phone:619-493-2103
Practice Address - Fax:619-493-2212
Is Sole Proprietor?:No
Enumeration Date:2012-02-14
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61171122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist