Provider Demographics
NPI:1326413279
Name:FLORES-LOPEZ, DARWIN ALEXANDER (RDH)
Entity Type:Individual
Prefix:
First Name:DARWIN
Middle Name:ALEXANDER
Last Name:FLORES-LOPEZ
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4153 ARCHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1666
Mailing Address - Country:US
Mailing Address - Phone:850-261-8070
Mailing Address - Fax:
Practice Address - Street 1:554 KEILY ST.
Practice Address - Street 2:BUREAU OF MEDICINE AND SURGERY-CREDENTIALS
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32212
Practice Address - Country:US
Practice Address - Phone:757-953-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11136124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist