Provider Demographics
NPI:1689077158
Name:MARY FLANAGAN LLC
Entity Type:Organization
Organization Name:MARY FLANAGAN LLC
Other - Org Name:PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:M
Authorized Official - Last Name:DRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:792-815-1977
Mailing Address - Street 1:777 RARITAN RD
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-2206
Mailing Address - Country:US
Mailing Address - Phone:732-818-1977
Mailing Address - Fax:732-815-1985
Practice Address - Street 1:777 RARITAN RD
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-2206
Practice Address - Country:US
Practice Address - Phone:732-815-1977
Practice Address - Fax:732-815-1985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty