Provider Demographics
NPI:1578850178
Name:FLANIGAN, JOHN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:FLANIGAN
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 1:4101 E WESLEY AVE
Mailing Address - Street 2:#9
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6050
Mailing Address - Country:US
Mailing Address - Phone:303-758-3935
Mailing Address - Fax:303-753-8659
Practice Address - Street 1:4101 E WESLEY AVE
Practice Address - Street 2:#9
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6050
Practice Address - Country:US
Practice Address - Phone:303-758-3935
Practice Address - Fax:303-753-8659
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO103071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice