Provider Demographics
NPI:1871694638
Name:BURQUEZ, FLORENCIO TOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:FLORENCIO
Middle Name:TOMAS
Last Name:BURQUEZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 FENTON ST
Mailing Address - Street 2:STE 102
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3599
Mailing Address - Country:US
Mailing Address - Phone:619-934-3477
Mailing Address - Fax:619-621-5668
Practice Address - Street 1:2452 FENTON ST
Practice Address - Street 2:STE 102
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3599
Practice Address - Country:US
Practice Address - Phone:619-934-3477
Practice Address - Fax:619-621-5668
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist