Healthcare Provider Details

I. General information

NPI: 1821302639
Provider Name (Legal Business Name): DAN JAMES FLOYD DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 12/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 GREEN ACRES RD STE 15
EUGENE OR
97408-1715
US

IV. Provider business mailing address

PO BOX 11470
EUGENE OR
97440-3670
US

V. Phone/Fax

Practice location:
  • Phone: 866-633-3113
  • Fax:
Mailing address:
  • Phone: 888-468-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD9456
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier500625069
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 2
IdentifierD9456
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerDENTAL LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: