Healthcare Provider Details

I. General information

NPI: 1295712800
Provider Name (Legal Business Name): VINCENT PAUL FLORYSHAK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TUSKEGEE BLVD
DOVER AFB DE
19902-5300
US

IV. Provider business mailing address

486 FAIRMONT DR
CHESTER SPRINGS PA
19425-3683
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-2549
  • Fax:
Mailing address:
  • Phone: 610-458-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS021321L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: