Provider Demographics
NPI:1265588644
Name:LOPEZ DEL RIO, NORKIS (DDS)
Entity type:Individual
Prefix:
First Name:NORKIS
Middle Name:
Last Name:LOPEZ DEL RIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:NORKIS
Other - Middle Name:
Other - Last Name:LOPEZ DEL RIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8613 OLD KINGS RD S
Mailing Address - Street 2:# 301
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32217-4807
Mailing Address - Country:US
Mailing Address - Phone:904-731-3889
Mailing Address - Fax:904-731-3912
Practice Address - Street 1:8613 OLD KINGS RD S
Practice Address - Street 2:# 301
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32217-4807
Practice Address - Country:US
Practice Address - Phone:904-731-3889
Practice Address - Fax:904-731-3912
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN175811223G0001X
CA524221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice