Provider Demographics
NPI:1730928201
Name:FLOSS LINCOLN PARK PLLC
Entity type:Organization
Organization Name:FLOSS LINCOLN PARK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISLAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NAEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-506-0795
Mailing Address - Street 1:1439 W FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2030
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1439 W FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2030
Practice Address - Country:US
Practice Address - Phone:313-506-0795
Practice Address - Fax:773-586-5534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental