Provider Demographics
NPI:1194201574
Name:FLYNN, MARCUS KEATING (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:KEATING
Last Name:FLYNN
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 1:14250 209TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98077-5664
Mailing Address - Country:US
Mailing Address - Phone:206-992-6480
Mailing Address - Fax:
Practice Address - Street 1:12917 SE 38TH ST STE 202
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98006-1349
Practice Address - Country:US
Practice Address - Phone:425-747-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE608642821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice