Provider Demographics
NPI:1104531045
Name:FLOYD FAMILY ORTHODONTICS HOLDINGS LLC
Entity type:Organization
Organization Name:FLOYD FAMILY ORTHODONTICS HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:503-878-8887
Mailing Address - Street 1:2148 SATTER ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-8335
Mailing Address - Country:US
Mailing Address - Phone:480-907-8987
Mailing Address - Fax:
Practice Address - Street 1:863 W MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-9352
Practice Address - Country:US
Practice Address - Phone:503-878-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty