Provider Demographics
NPI:1265859300
Name:FLINT, TY (DDS)
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:FLINT
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 1:1576 PHILLIPS ST
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9599
Mailing Address - Country:US
Mailing Address - Phone:801-726-2119
Mailing Address - Fax:
Practice Address - Street 1:1147 ROSEWOOD LN STE 1
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5116
Practice Address - Country:US
Practice Address - Phone:801-544-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-26
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9054864-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice