Healthcare Provider Details

I. General information

NPI: 1700107182
Provider Name (Legal Business Name): JOHN JOSPEH FLYNN D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2010
Last Update Date: 06/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 CHAPEL RIDGE DR
PITTSBORO NC
27312-9539
US

IV. Provider business mailing address

633 CHAPEL RIDGE DR
PITTSBORO NC
27312-9539
US

V. Phone/Fax

Practice location:
  • Phone: 919-360-3106
  • Fax:
Mailing address:
  • Phone: 919-360-3106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8985
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: