Provider Demographics
NPI:1356554208
Name:JOHN W FLOREN DMD PA
Entity type:Organization
Organization Name:JOHN W FLOREN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:FLOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-980-3333
Mailing Address - Street 1:1307 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-2336
Mailing Address - Country:US
Mailing Address - Phone:803-980-3333
Mailing Address - Fax:803-980-2990
Practice Address - Street 1:1307 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2336
Practice Address - Country:US
Practice Address - Phone:803-980-3333
Practice Address - Fax:803-980-2990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC4981223E0200X
SCSC33171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty