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NPI Code Detail

MEDICARE: PAUL M. FLYNN, DDS, PC

MEDICARE: PAUL M. FLYNN, DDS, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QS0112XOral and Maxillofacial Surgery Clinic/Center2901011737MI

General Provider Information

NPI Number : 1356782155
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAUL M. FLYNN, DDS, PC
Provider Business Mailing Address
First Line : 4124 W ST JOE HWY
Second Line :
City : LANSING
State : MI
Zip : 48917-5205
Country : US
Telephone Number : 517-321-3236
Fax Number : 517-321-7313
Provider Business Practice Location Address
First Line : 4124 W ST JOE HWY
Second Line :
City : LANSING
State : MI
Zip : 48917-5205
Country : US
Telephone Number : 517-321-3236
Fax Number : 517-321-7313
Authorized Official
Title or Position : OWNER
Name : DR. PAUL MICHAEL FLYNN
Credential : DDS
Telephone Number : 517-321-3236
Provider Enumeration Date : 07/10/2013
Last Update Date : 02/03/2014

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