Healthcare Provider Details

I. General information

NPI: 1013209170
Provider Name (Legal Business Name): FLYNN DENTISTRY KAYSVILLE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2011
Last Update Date: 05/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 S MAIN ST
KAYSVILLE UT
84037-2503
US

IV. Provider business mailing address

206 S MAIN ST
KAYSVILLE UT
84037-2503
US

V. Phone/Fax

Practice location:
  • Phone: 801-497-0619
  • Fax: 801-497-0316
Mailing address:
  • Phone: 801-497-0619
  • Fax: 801-497-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5097188-9922
License Number StateUT

VIII. Authorized Official

Name: DR. ROBERT M. FLYNN
Title or Position: MANAGING MEMBER
Credential: D.M.D.
Phone: 801-497-0619