Provider Demographics
NPI:1376777920
Name:FLANIGAN, MARIA MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:MICHELLE
Last Name:FLANIGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:MICHELLE
Other - Last Name:LANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5220 BAILEY RD SW
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-4737
Mailing Address - Country:US
Mailing Address - Phone:770-330-6585
Mailing Address - Fax:
Practice Address - Street 1:5220 BAILEY RD SW
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-4737
Practice Address - Country:US
Practice Address - Phone:770-330-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0138621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice