Provider Demographics
NPI:1275209629
Name:THE FLOSS'N XPERTS
Entity Type:Organization
Organization Name:THE FLOSS'N XPERTS
Other - Org Name:THE FOSS'N XPERTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BORQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-647-4459
Mailing Address - Street 1:2700 ADAMS AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1367
Mailing Address - Country:US
Mailing Address - Phone:619-647-4459
Mailing Address - Fax:
Practice Address - Street 1:2700 ADAMS AVE STE 209
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1367
Practice Address - Country:US
Practice Address - Phone:619-647-4459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770649337Medicaid