Provider Demographics
NPI:1730351800
Name:GROSS AND FLORES DDS PC
Entity type:Organization
Organization Name:GROSS AND FLORES DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:845-452-6110
Mailing Address - Street 1:12 DAVIS AVE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2408
Mailing Address - Country:US
Mailing Address - Phone:845-473-4565
Mailing Address - Fax:
Practice Address - Street 1:12 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2408
Practice Address - Country:US
Practice Address - Phone:845-473-4565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-29
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY359771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01934963Medicaid