Provider Demographics
NPI:1982174108
Name:FLOSS N GLOSS DENTAL PC
Entity Type:Organization
Organization Name:FLOSS N GLOSS DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING CORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-229-1441
Mailing Address - Street 1:114 LEE STREET
Mailing Address - Street 2:
Mailing Address - City:DESPLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016
Mailing Address - Country:US
Mailing Address - Phone:224-567-8539
Mailing Address - Fax:224-567-8903
Practice Address - Street 1:114 LEE STREET
Practice Address - Street 2:
Practice Address - City:DESPLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:224-567-8539
Practice Address - Fax:224-567-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty