Healthcare Provider Details

I. General information

NPI: 1407320229
Provider Name (Legal Business Name): PRISCILLA FLYNN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2019
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 W CENTER ST STE 130
ROCHESTER MN
55902-6278
US

IV. Provider business mailing address

515 DELAWARE ST SE
MINNEAPOLIS MN
55455-0357
US

V. Phone/Fax

Practice location:
  • Phone: 507-529-0436
  • Fax:
Mailing address:
  • Phone: 612-625-9121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH2679
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: