Provider Demographics
NPI:1962604488
Name:FLORES, JOAN MANUEL (DMD)
Entity type:Individual
Prefix:MR
First Name:JOAN
Middle Name:MANUEL
Last Name:FLORES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11890 SW 8TH ST
Mailing Address - Street 2:SUITE # 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1743
Mailing Address - Country:US
Mailing Address - Phone:305-562-5776
Mailing Address - Fax:305-485-0080
Practice Address - Street 1:11890 SW 8TH ST
Practice Address - Street 2:SUITE # 300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1743
Practice Address - Country:US
Practice Address - Phone:305-562-5776
Practice Address - Fax:305-485-0080
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist