Provider Demographics
NPI:1104010024
Name:FLORES, AUGUSTO, DMD , INC
Entity type:Organization
Organization Name:FLORES, AUGUSTO, DMD , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:SEVILLA
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:626-332-8608
Mailing Address - Street 1:4708 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-2005
Mailing Address - Country:US
Mailing Address - Phone:626-332-8608
Mailing Address - Fax:626-332-8216
Practice Address - Street 1:4708 N GRAND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-2005
Practice Address - Country:US
Practice Address - Phone:626-332-8608
Practice Address - Fax:626-332-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA378221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB37822-02OtherMEDI-CAL