Provider Demographics
NPI:1457589715
Name:DRFLASH
Entity Type:Organization
Organization Name:DRFLASH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:630-878-0351
Mailing Address - Street 1:23657 W ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-8012
Mailing Address - Country:US
Mailing Address - Phone:630-878-0351
Mailing Address - Fax:815-254-9746
Practice Address - Street 1:23657 W ORCHARD LN
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60586-8012
Practice Address - Country:US
Practice Address - Phone:630-878-0351
Practice Address - Fax:815-254-9746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-25
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019020648122300000X
292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No292200000XLaboratoriesDental LaboratoryGroup - Single Specialty