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General NPI Number Information
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NPI Number | 1528490562
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Entity Type | Organization
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Legal Business Name | FLOSSMORE DENTAL
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Dates
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Enumeration Date | 08/01/2013
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Last Update Date | 08/01/2013
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Provider Practice Location Address
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Address Line | 1382 EAST BELTLINE ROAD
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City | RICHARDSON
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State | TX
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Zip | 75081
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Country | US
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Telephone | 469-360-8522
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Fax |
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Provider Business Mailing Address
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Address Line | 2605 DESERT FALLS LN
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City | ROCKWALL
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State | TX
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Zip | 75087-2466
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | HANK CHANG
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Credential |
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Telephone | 469-360-8522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22343
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License Number State | TX
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