Healthcare Provider Details

I. General information

NPI: 1285766139
Provider Name (Legal Business Name): ALTON FLYNN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 HYDE PARK BLVD STE 100
CLEBURNE TX
76033-4524
US

IV. Provider business mailing address

2213 LAKESHORE DR
CLEBURNE TX
76033-6967
US

V. Phone/Fax

Practice location:
  • Phone: 817-645-7201
  • Fax: 817-645-5273
Mailing address:
  • Phone: 817-558-8765
  • Fax: 817-645-5273

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7465
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: