Provider Demographics
NPI:1336634765
Name:FLOSI, CAITLIN LANGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:LANGE
Last Name:FLOSI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:MARIE
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:757 LAKE CAROLYN PKWY APT 2240
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4531
Mailing Address - Country:US
Mailing Address - Phone:513-520-8254
Mailing Address - Fax:
Practice Address - Street 1:5720 LOCKE AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5020
Practice Address - Country:US
Practice Address - Phone:817-653-8859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist