Provider Demographics
NPI:1013209170
Name:FLYNN DENTISTRY KAYSVILLE, INC.
Entity Type:Organization
Organization Name:FLYNN DENTISTRY KAYSVILLE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-497-0619
Mailing Address - Street 1:206 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2503
Mailing Address - Country:US
Mailing Address - Phone:801-497-0619
Mailing Address - Fax:801-497-0316
Practice Address - Street 1:206 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2503
Practice Address - Country:US
Practice Address - Phone:801-497-0619
Practice Address - Fax:801-497-0316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5097188-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty