Provider Demographics
NPI:1356415749
Name:FLINK, DARA TASSON (DDS)
Entity type:Individual
Prefix:DR
First Name:DARA
Middle Name:TASSON
Last Name:FLINK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2052 RUSH CT
Mailing Address - Street 2:
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115-4147
Mailing Address - Country:US
Mailing Address - Phone:920-338-0085
Mailing Address - Fax:
Practice Address - Street 1:2805 LIBAL ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2877
Practice Address - Country:US
Practice Address - Phone:920-339-9013
Practice Address - Fax:920-339-5741
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5480-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice