Provider Demographics
NPI:1063636686
Name:FLACK, DAVID O (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:O
Last Name:FLACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 S KIPLING PKWY
Mailing Address - Street 2:STE B-2
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-7931
Mailing Address - Country:US
Mailing Address - Phone:614-738-1035
Mailing Address - Fax:
Practice Address - Street 1:5035 S KIPLING PKWY
Practice Address - Street 2:STE B-2
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-7931
Practice Address - Country:US
Practice Address - Phone:614-738-1035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9897122300000X
OH0224021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2671998Medicaid