Provider Demographics
NPI:1902934060
Name:PLATA FLORES, RAUL EDMUNDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:EDMUNDO
Last Name:PLATA FLORES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:RAUL
Other - Middle Name:E
Other - Last Name:PLATA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8704 LEE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-2104
Mailing Address - Country:US
Mailing Address - Phone:703-573-4455
Mailing Address - Fax:703-573-4455
Practice Address - Street 1:8704 LEE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2104
Practice Address - Country:US
Practice Address - Phone:703-573-4455
Practice Address - Fax:703-573-4455
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401007705122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist