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General NPI Number Information
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NPI Number | 1861260689
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Entity Type | Organization
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Legal Business Name | FLOSSIN IN CLAWSON
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 430 S MAIN ST
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City | CLAWSON
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State | MI
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Zip | 48017-2012
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Country | US
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Telephone | 248-288-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 55 S MAIN ST
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City | CLARKSTON
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State | MI
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Zip | 48346-1527
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Country | US
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Telephone | 248-707-5025
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIFFANY MEGAN DANYAL
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Credential | DDS
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Telephone | 248-707-2505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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