Provider Demographics
NPI:1295174795
Name:FLANNAGAN, KEVIN M (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:FLANNAGAN
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 1:522 E STATE ROAD 32
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8767
Mailing Address - Country:US
Mailing Address - Phone:317-867-5511
Mailing Address - Fax:317-867-4111
Practice Address - Street 1:12525 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9150
Practice Address - Country:US
Practice Address - Phone:317-571-9610
Practice Address - Fax:317-571-9620
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011979A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist