Provider Demographics
NPI:1326285032
Name:FLYNN, TIMOTHY J (DMD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:FLYNN
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:PARQUE DE VILLA CAPARRA
Mailing Address - Street 2:#25 ZUANIA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966
Mailing Address - Country:US
Mailing Address - Phone:787-586-9939
Mailing Address - Fax:
Practice Address - Street 1:CALLE EL BUEN SAMARITANO D-17
Practice Address - Street 2:JUAN DOMINGO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966
Practice Address - Country:US
Practice Address - Phone:787-200-4902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-16
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics