Healthcare Provider Details

I. General information

NPI: 1023163649
Provider Name (Legal Business Name): SEAN MONTAGUE FLYNN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 BROAD RIVER RD
COLUMBIA SC
29210-7006
US

IV. Provider business mailing address

1100 PULASKI ST APT. 815
COLUMBIA SC
29201-3644
US

V. Phone/Fax

Practice location:
  • Phone: 803-772-3630
  • Fax:
Mailing address:
  • Phone: 803-608-3549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number4115
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: