Provider Demographics
NPI:1871373787
Name:FLOSS ACADEMY, PLLC
Entity type:Organization
Organization Name:FLOSS ACADEMY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUSKOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:815-830-2809
Mailing Address - Street 1:1448 W MADISON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-1822
Mailing Address - Country:US
Mailing Address - Phone:312-584-0447
Mailing Address - Fax:
Practice Address - Street 1:1448 W MADISON ST STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-1822
Practice Address - Country:US
Practice Address - Phone:312-584-0447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-29
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty