Healthcare Provider Details

I. General information

NPI: 1821930108
Provider Name (Legal Business Name): DIVINE DENTAL ANNAPOLIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

37 OLD SOLOMONS ISLAND RD STE 1
ANNAPOLIS MD
21401-3985
US

IV. Provider business mailing address

4801 RITCHIE HWY
BALTIMORE MD
21225-3045
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-4411
  • Fax:
Mailing address:
  • Phone: 410-789-5228
  • Fax: 410-789-2162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: FREDERICK J FLANAGAN II
Title or Position: OWNER
Credential: DDS
Phone: 410-789-5228