Provider Demographics
NPI:1629169909
Name:FLYNN, MICHAEL THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
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 1:27249 RUSLYNN DR
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-4971
Mailing Address - Country:US
Mailing Address - Phone:507-452-9035
Mailing Address - Fax:507-457-3269
Practice Address - Street 1:560 DEBRA DR
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:MN
Practice Address - Zip Code:55952-2104
Practice Address - Country:US
Practice Address - Phone:507-523-2267
Practice Address - Fax:507-523-2206
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN87591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN063218000Medicaid