Provider Demographics
NPI:1588297246
Name:MOOS, FLORENCE E (DENTAL HYGIENIST)
Entity type:Individual
Prefix:
First Name:FLORENCE
Middle Name:E
Last Name:MOOS
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W CHICAGO AVE STE F
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3261
Mailing Address - Country:US
Mailing Address - Phone:219-703-2583
Mailing Address - Fax:219-703-6749
Practice Address - Street 1:1802 E COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:EAST CHICAGO
Practice Address - State:IN
Practice Address - Zip Code:46312-2826
Practice Address - Country:US
Practice Address - Phone:219-397-6916
Practice Address - Fax:219-397-9313
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13002162A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN13002162AOtherINDIANA LICENSE