Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 206 | NC |
NPI | 1720455686 |
---|---|
Provider Name | Andres David Flores |
First Address | Greenville, NC 27834-5925 |
Second Address | Greenville, NC 27834-5925 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2015 |
Last Update Date | 12/07/2021 |