Organization
FLOSS DENTAL STUDIO PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHELLE ANN RADEKA DMD (OWNER/PRES/DENTIST)
(773) 235-2322
Entity
Organization
Contact information
Practice address
924 N DAMEN AVE, CHICAGO, IL 60622-4948
(773) 235-2322
(773) 235-2332
Mailing address
PO BOX 221018, CHICAGO, IL 60622-0008
(773) 235-2322
(773) 235-2332
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019025071
IL
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
03/24/2015
Last updated
04/23/2015
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