Provider Demographics
NPI:1568434827
Name:FLANAGAN, DENISE A (DDS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 NAAB ROAD
Mailing Address - Street 2:STE 355
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-876-1095
Mailing Address - Fax:317-875-7275
Practice Address - Street 1:8240 NAAB ROAD
Practice Address - Street 2:STE 355
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-876-1095
Practice Address - Fax:317-875-7275
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009664122300000X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200182630AMedicaid
IN000000093138OtherANTHEM BLUE CROSS
U90373Medicare UPIN