Provider Demographics
NPI:1780690016
Name:FLYNN, MARY ORLAINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:ORLAINE
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3939 W 50TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55424-1244
Mailing Address - Country:US
Mailing Address - Phone:952-922-5561
Mailing Address - Fax:952-922-8214
Practice Address - Street 1:3939 W 50TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1244
Practice Address - Country:US
Practice Address - Phone:952-922-5561
Practice Address - Fax:952-922-8214
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MND94721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU45722Medicare UPIN