Provider Demographics
NPI:1891895546
Name:FLYNN, JOHN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
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 1:4607 CONNECTICUT AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-5741
Mailing Address - Country:US
Mailing Address - Phone:202-966-5655
Mailing Address - Fax:202-364-2993
Practice Address - Street 1:4607 CONNECTICUT AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-5741
Practice Address - Country:US
Practice Address - Phone:202-966-5655
Practice Address - Fax:202-364-2993
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
166629Medicare UPIN
DC166629Medicare ID - Type Unspecified