=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245478973
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTALFLOSSOPHY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2009
-----------------------------------------------------
Last Update Date | 02/03/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4300 MATLOCK RD SUITE 120
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76018-5258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-466-9972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4300 MATLOCK RD SUITE 120
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76018-5258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-466-9972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR
-----------------------------------------------------
Name | MRS. NANCY H BUI
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 817-466-9972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 18926
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------