Healthcare Provider Details

I. General information

NPI: 1568434827
Provider Name (Legal Business Name): DENISE A FLANAGAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 12/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 NAAB ROAD STE 355
INDIANAPOLIS IN
46260
US

IV. Provider business mailing address

8240 NAAB ROAD STE 355
INDIANAPOLIS IN
46260
US

V. Phone/Fax

Practice location:
  • Phone: 317-876-1095
  • Fax: 317-875-7275
Mailing address:
  • Phone: 317-876-1095
  • Fax: 317-875-7275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12009664
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12009664
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: