Provider Demographics
NPI:1467460964
Name:FLYNN, MICHAEL HARRISON (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HARRISON
Last Name:FLYNN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SCRIPPS DR
Mailing Address - Street 2:#2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6316
Mailing Address - Country:US
Mailing Address - Phone:916-929-4135
Mailing Address - Fax:916-923-7473
Practice Address - Street 1:103 SCRIPPS DR
Practice Address - Street 2:#2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6316
Practice Address - Country:US
Practice Address - Phone:916-929-4135
Practice Address - Fax:916-923-7473
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB23500Medicaid