Healthcare Provider Details

I. General information

NPI: 1982449237
Provider Name (Legal Business Name): MARIAH FLYNN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 BEACON ST STE 201
BROOKLINE MA
02446-4965
US

IV. Provider business mailing address

1371 BEACON ST STE 201
BROOKLINE MA
02446-4965
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-2734
  • Fax:
Mailing address:
  • Phone: 617-566-2734
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10001029
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: