Provider Demographics
NPI:1548459803
Name:FLORES, JUAN CARLOS (DMD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:FLORES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7171 CORAL WAY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1449
Mailing Address - Country:US
Mailing Address - Phone:305-264-9191
Mailing Address - Fax:
Practice Address - Street 1:7171 CORAL WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1449
Practice Address - Country:US
Practice Address - Phone:305-264-9191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-23
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0536081122300000X
FLDN17732122300000X
FL177321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist