MEDICARE: DR. CAITLIN LANGE FLOSI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	34220	TX

General Provider Information

NPI Number	:	1336634765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAITLIN LANGE FLOSI DDS

Provider Business Mailing Address
First Line	:	757 LAKE CAROLYN PKWY APT 2240
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75039-4531
Country	:	US
Telephone Number	:	513-520-8254
Fax Number	:

Provider Business Practice Location Address
First Line	:	5720 LOCKE AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-5020
Country	:	US
Telephone Number	:	817-653-8859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	06/27/2018

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