Provider Demographics
NPI:1750415360
Name:HER-FLORES, MAO (DDS)
Entity type:Individual
Prefix:DR
First Name:MAO
Middle Name:
Last Name:HER-FLORES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MAO
Other - Middle Name:
Other - Last Name:HER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:650 ZEDIKER AVE.
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-0790
Mailing Address - Country:US
Mailing Address - Phone:559-646-6618
Mailing Address - Fax:559-646-6614
Practice Address - Street 1:517 S MADERA AVE
Practice Address - Street 2:
Practice Address - City:KERMAN
Practice Address - State:CA
Practice Address - Zip Code:93630-1523
Practice Address - Country:US
Practice Address - Phone:559-846-6330
Practice Address - Fax:559-842-2375
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA47728OtherCALIFORNIA DENTAL LIC#