Provider Demographics
NPI:1396862553
Name:ROBERT D FLANNIGAN D.D.S. L.L.C.
Entity Type:Organization
Organization Name:ROBERT D FLANNIGAN D.D.S. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:FLANNIGAN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-486-2312
Mailing Address - Street 1:305 WEST DREW AVE.
Mailing Address - Street 2:P.O. BOX 449
Mailing Address - City:MONETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72447-0449
Mailing Address - Country:US
Mailing Address - Phone:870-486-2312
Mailing Address - Fax:870-486-2419
Practice Address - Street 1:305 WEST DREW AVE
Practice Address - Street 2:
Practice Address - City:MONETTE
Practice Address - State:AR
Practice Address - Zip Code:72447-0449
Practice Address - Country:US
Practice Address - Phone:870-486-2312
Practice Address - Fax:870-486-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR22511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5C911OtherBLUE CROSS BLUE SHIELD