Provider Demographics
NPI:1588742142
Name:FLOYD, R. EARL (DDS, PS)
Entity type:Individual
Prefix:DR
First Name:R.
Middle Name:EARL
Last Name:FLOYD
Suffix:
Gender:M
Credentials:DDS, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7290
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-0850
Mailing Address - Country:US
Mailing Address - Phone:253-863-5188
Mailing Address - Fax:253-863-4751
Practice Address - Street 1:18310 HWY 410 E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-0850
Practice Address - Country:US
Practice Address - Phone:253-863-5188
Practice Address - Fax:253-863-4751
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3931122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist