Provider Demographics
NPI:1023117546
Name:FLOOR, THEODORE A (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:A
Last Name:FLOOR
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 1:10055 N PORTAL AVE
Mailing Address - Street 2:#100
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-2371
Mailing Address - Country:US
Mailing Address - Phone:408-255-4500
Mailing Address - Fax:408-255-4586
Practice Address - Street 1:10055 N PORTAL AVE
Practice Address - Street 2:#100
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2371
Practice Address - Country:US
Practice Address - Phone:408-255-4500
Practice Address - Fax:408-255-4586
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice