Provider Demographics
NPI:1598816456
Name:FLORES, MARITZA IVETTE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:IVETTE
Last Name:FLORES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0899
Mailing Address - Country:US
Mailing Address - Phone:787-787-4360
Mailing Address - Fax:
Practice Address - Street 1:DD-3 RAMON LUIZ RODRIGUEZ AVE.
Practice Address - Street 2:FLAMBOYAN GARDENS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-787-4360
Practice Address - Fax:787-787-4365
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1290122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist