Individual
DR. GUSTAVO E LORES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2005 KNIGHT LANE BLDG H, NAVY MEDICINE SUPPORT COMMAND, JACKSONVILLE, FL 32212-0140
(904) 542-7200
Mailing address
1 PINCKNEY BLVD, NAVAL HOSPITAL BEAUFORT, BEAUFORT, SC 29902-6122
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
17760
FL
1223P0700X
Prosthodontics
Primary
17760
FL
Other
Enumeration date
10/11/2006
Last updated
12/27/2023
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