Provider Demographics
NPI:1215018288
Name:FLOOK, NATHANIEL W (DMD)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:W
Last Name:FLOOK
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 1:1843 HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-1311
Mailing Address - Country:US
Mailing Address - Phone:570-759-0145
Mailing Address - Fax:570-752-6806
Practice Address - Street 1:105 W 9TH ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-3024
Practice Address - Country:US
Practice Address - Phone:570-752-4542
Practice Address - Fax:570-752-6806
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0361211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009766460002Medicaid