Healthcare Provider Details

I. General information

NPI: 1407697196
Provider Name (Legal Business Name): MARIA QUESADA FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 07/23/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

IV. Provider business mailing address

403 E 11TH ST
PANAMA CITY FL
32401-3409
US

V. Phone/Fax

Practice location:
  • Phone: 850-767-3350
  • Fax: 850-872-3353
Mailing address:
  • Phone: 850-747-5599
  • Fax: 850-872-4131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN30530
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: