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General NPI Number Information
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NPI Number | 1760889497
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Entity Type | Organization
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Legal Business Name | FLOSS FAMILY DENTISTRY, LLCS
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 7700 OLD BRANCH AVE D105
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City | CLINTON
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State | MD
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Zip | 20735-1628
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Country | US
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Telephone | 240-348-7292
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Fax |
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Provider Business Mailing Address
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Address Line | 7700 OLD BRANCH AVE D105
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City | CLINTON
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State | MD
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Zip | 20735-1628
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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 | OWNER
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Name | DR. PATRICE D BREGGS
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Credential | DDS
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Telephone | 240-348-7292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 14653
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License Number State | MD
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