Provider Demographics
NPI:1548486277
Name:FLORES, MARIO (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:
Last Name:FLORES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIO
Other - Middle Name:
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:9330 BASELINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-5827
Mailing Address - Country:US
Mailing Address - Phone:909-483-0271
Mailing Address - Fax:909-483-0270
Practice Address - Street 1:9330 BASELINE RD STE 101
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-5827
Practice Address - Country:US
Practice Address - Phone:909-483-0271
Practice Address - Fax:909-483-0270
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323011223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics