Healthcare Provider Details

I. General information

NPI: 1801998323
Provider Name (Legal Business Name): PAULA C. FLYNN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 STRAD AVE 206
NORTH TONAWANDA NY
14120-3061
US

IV. Provider business mailing address

1333 STRAD AVE 206
NORTH TONAWANDA NY
14120-3061
US

V. Phone/Fax

Practice location:
  • Phone: 716-694-6935
  • Fax:
Mailing address:
  • Phone: 716-694-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number036911
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: