Provider Demographics
NPI:1023163649
Name:FLYNN, SEAN MONTAGUE (DMD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:MONTAGUE
Last Name:FLYNN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 PULASKI ST
Mailing Address - Street 2:APT. 815
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-3644
Mailing Address - Country:US
Mailing Address - Phone:803-608-3549
Mailing Address - Fax:
Practice Address - Street 1:2007 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7006
Practice Address - Country:US
Practice Address - Phone:803-772-3630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4115122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist