Healthcare Provider Details

I. General information

NPI: 1730928201
Provider Name (Legal Business Name): FLOSS LINCOLN PARK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 W FULLERTON AVE
CHICAGO IL
60614-2030
US

IV. Provider business mailing address

1439 W FULLERTON AVE
CHICAGO IL
60614-2030
US

V. Phone/Fax

Practice location:
  • Phone: 313-506-0795
  • Fax: 773-586-5534
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ISLAM NAEM
Title or Position: PARTNER/OWNER
Credential: DDS
Phone: 313-506-0795