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General NPI Number Information
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NPI Number | 1104531045
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Entity Type | Organization
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Legal Business Name | FLOYD FAMILY ORTHODONTICS HOLDINGS LLC
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Dates
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Enumeration Date | 01/16/2023
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 863 W MAIN ST STE 200
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City | MOLALLA
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State | OR
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Zip | 97038-9352
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Country | US
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Telephone | 503-878-8887
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Fax |
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Provider Business Mailing Address
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Address Line | 2148 SATTER ST
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City | WEST LINN
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State | OR
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Zip | 97068-8335
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Country | US
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Telephone | 480-907-8987
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL FLOYD
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Credential | DMD, MS
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Telephone | 503-878-8887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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