MEDICARE: FLOSS DENTAL PC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1821868910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOSS DENTAL PC

Provider Business Mailing Address
First Line	:	526 TENNYSON DR
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-6437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1340 FOREST AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10302-2002
Country	:	US
Telephone Number	:	347-620-0450
Fax Number	:

Authorized Official
Title or Position	:	DR.
Name	:	GABRIEL MILGROM
Credential	:
Telephone Number	:	347-620-0450

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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Directions to “FLOSS DENTAL PC ” Practice Location

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