Provider Demographics
NPI:1740911643
Name:THE FRIENDLY FLOSSER DENTAL HYGIENE PRACTICE OF JENNIFER NOWOTNEY
Entity type:Organization
Organization Name:THE FRIENDLY FLOSSER DENTAL HYGIENE PRACTICE OF JENNIFER NOWOTNEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:NOWOTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:909-900-8880
Mailing Address - Street 1:12647 TRILLIUM CT
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1535
Mailing Address - Country:US
Mailing Address - Phone:909-268-7922
Mailing Address - Fax:
Practice Address - Street 1:11799 SEBASTIAN WAY STE 103
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0708
Practice Address - Country:US
Practice Address - Phone:909-900-8880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-21
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty