Provider Demographics
NPI:1265502462
Name:FLATLEY, MICHAEL P (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:FLATLEY
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 1:4423 PT FOSDICK DR
Mailing Address - Street 2:STE 304
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1794
Mailing Address - Country:US
Mailing Address - Phone:253-853-4955
Mailing Address - Fax:253-853-4957
Practice Address - Street 1:4423 PT FOSDICK DR
Practice Address - Street 2:STE 304
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1794
Practice Address - Country:US
Practice Address - Phone:253-853-4955
Practice Address - Fax:253-853-4957
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00006468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist