Provider Demographics
NPI:1508424813
Name:FLANAGIN, DALE ROBERT II
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:ROBERT
Last Name:FLANAGIN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14254 N CLIO RD
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:MI
Mailing Address - Zip Code:48420-8868
Mailing Address - Country:US
Mailing Address - Phone:810-336-5373
Mailing Address - Fax:
Practice Address - Street 1:1124 28TH ST SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49509-2855
Practice Address - Country:US
Practice Address - Phone:616-530-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-01
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901023168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist