Healthcare Provider Details

I. General information

NPI: 1174494678
Provider Name (Legal Business Name): DR. DYLAN T FLYNN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 07/04/2026
Certification Date: 07/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 N CALE ST
POSEYVILLE IN
47633-9001
US

IV. Provider business mailing address

1208 FOREST HILLS DR
VINCENNES IN
47591-3602
US

V. Phone/Fax

Practice location:
  • Phone: 812-874-2235
  • Fax:
Mailing address:
  • Phone: 812-899-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12014988A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: