Provider Demographics
NPI:1083073431
Name:FLOUMANHAFT, MARK (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FLOUMANHAFT
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 1:253 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2018
Mailing Address - Country:US
Mailing Address - Phone:716-550-6137
Mailing Address - Fax:
Practice Address - Street 1:253 CLUB DR
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2018
Practice Address - Country:US
Practice Address - Phone:716-550-6137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-14
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY059391122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist