Provider Demographics
NPI:1275984866
Name:FLYNN, LAURA LEE (DMD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LEE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 ELMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02889-4513
Mailing Address - Country:US
Mailing Address - Phone:401-339-1917
Mailing Address - Fax:
Practice Address - Street 1:1126 HARTFORD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-7109
Practice Address - Country:US
Practice Address - Phone:401-351-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-25
Last Update Date:2016-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICDEN03301122300000X
RIDEN03301122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist