Provider Demographics
NPI:1306001110
Name:DENTAL CARE BY THE SQUARE
Entity Type:Organization
Organization Name:DENTAL CARE BY THE SQUARE
Other - Org Name:WASHINGTON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:FLORYANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:319-653-3412
Mailing Address - Street 1:1051 WEST MADISON STREET
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353
Mailing Address - Country:US
Mailing Address - Phone:319-653-3412
Mailing Address - Fax:319-653-5511
Practice Address - Street 1:1051 WEST MADISON STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353
Practice Address - Country:US
Practice Address - Phone:319-653-3412
Practice Address - Fax:319-653-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122300000X
IA8563305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No305S00000XManaged Care OrganizationsPoint of ServiceGroup - Single Specialty