Provider Demographics
NPI:1417932518
Name:FLANNERY, MICHAEL BENJAMIN (DMD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BENJAMIN
Last Name:FLANNERY
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:PSC 557 BOX 2972
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379-2972
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3D DEN/BN USNDC
Practice Address - Street 2:UNIT#38450
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-8450
Practice Address - Country:JP
Practice Address - Phone:645-7381
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist