Provider Demographics
NPI:1891891248
Name:FLORES, JOE STEVAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:STEVAN
Last Name:FLORES
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 S LAMAR BLVD
Mailing Address - Street 2:391
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8801
Mailing Address - Country:US
Mailing Address - Phone:512-443-5704
Mailing Address - Fax:512-443-5709
Practice Address - Street 1:3901 S LAMAR BLVD
Practice Address - Street 2:391
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8801
Practice Address - Country:US
Practice Address - Phone:512-443-5704
Practice Address - Fax:512-443-5709
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX168281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics