Healthcare Provider Details

I. General information

NPI: 1205459153
Provider Name (Legal Business Name): TYLER SCOTT FLYNN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 BOULDER ROCK DR STE A
PALM COAST FL
32137-8538
US

IV. Provider business mailing address

5 BOULDER ROCK DR STE A
PALM COAST FL
32137-8538
US

V. Phone/Fax

Practice location:
  • Phone: 386-276-9051
  • Fax: 386-276-9053
Mailing address:
  • Phone: 386-276-9051
  • Fax: 386-276-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.032582
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: