Provider Demographics
NPI:1275730475
Name:FLORES, FELIPE (DMD)
Entity Type:Individual
Prefix:MR
First Name:FELIPE
Middle Name:
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 1:4227 SW SANTA BARBARA PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-9308
Mailing Address - Country:US
Mailing Address - Phone:239-274-6664
Mailing Address - Fax:239-267-2106
Practice Address - Street 1:18070 S TAMIAMI TRL STE 14
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4602
Practice Address - Country:US
Practice Address - Phone:239-274-6664
Practice Address - Fax:239-267-2106
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16964122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist