MEDICARE: FLOSSOPHY PLLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1952937401
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLOSSOPHY PLLLC

Provider Business Mailing Address
First Line	:	33200 W 14 MILE RD STE 190
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3570
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	33200 W 14 MILE RD STE 190
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3570
Country	:	US
Telephone Number	:	248-847-3828
Fax Number	:

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	VISHNU BURLA
Credential	:
Telephone Number	:	248-848-3828

Provider Enumeration Date	:	03/17/2020
Last Update Date	:	03/17/2020

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Directions to “FLOSSOPHY PLLLC ” Practice Location

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