Healthcare Provider Details

I. General information

NPI: 1205574258
Provider Name (Legal Business Name): KRISTA FLANAGAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2022
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WYOMING AVE STE 300
SCRANTON PA
18503-1238
US

IV. Provider business mailing address

707 DAFFODIL CT
EXETER PA
18643-1171
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-8800
  • Fax:
Mailing address:
  • Phone: 570-706-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS043638
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: