Healthcare Provider Details

I. General information

NPI: 1396271003
Provider Name (Legal Business Name): JOSEPHINE FLYNN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSEPHINE VARGAS D.M.D.

II. Dates (important events)

Enumeration Date: 05/02/2017
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11416 SHELBYVILLE RD
LOUISVILLE KY
40243-1306
US

IV. Provider business mailing address

3908 WINCHESTER RD
LOUISVILLE KY
40207-3819
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-8442
  • Fax:
Mailing address:
  • Phone: 631-404-5366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10750
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: