Healthcare Provider Details

I. General information

NPI: 1639152358
Provider Name (Legal Business Name): DENNIS JOSEPH FLANAGAN D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 FEATHERSTONE RD
ROCKFORD IL
61107-5906
US

IV. Provider business mailing address

1075 FEATHERSTONE RD
ROCKFORD IL
61107-5906
US

V. Phone/Fax

Practice location:
  • Phone: 815-399-5757
  • Fax:
Mailing address:
  • Phone: 815-399-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: