Provider Demographics
NPI:1154457588
Name:FLANAGAN, THOMAS J (DMD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:FLANAGAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S MANLIUS ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-2041
Mailing Address - Country:US
Mailing Address - Phone:315-663-0295
Mailing Address - Fax:
Practice Address - Street 1:300 S MANLIUS ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2041
Practice Address - Country:US
Practice Address - Phone:315-663-0295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040741-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics