Provider Demographics
NPI:1790004778
Name:FLAGG, BRIENNE MORELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIENNE
Middle Name:MORELLE
Last Name:FLAGG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:BRIENNE
Other - Middle Name:
Other - Last Name:FLAGG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1006 N BARRETT LN
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-6910
Mailing Address - Country:US
Mailing Address - Phone:302-981-3925
Mailing Address - Fax:
Practice Address - Street 1:1006 N BARRETT LN
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-6910
Practice Address - Country:US
Practice Address - Phone:302-981-3925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS038264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist