Healthcare Provider Details

I. General information

NPI: 1194201574
Provider Name (Legal Business Name): MARCUS KEATING FLYNN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12917 SE 38TH ST STE 202
BELLEVUE WA
98006-1349
US

IV. Provider business mailing address

14250 209TH AVE NE
WOODINVILLE WA
98077-5664
US

V. Phone/Fax

Practice location:
  • Phone: 425-747-8052
  • Fax:
Mailing address:
  • Phone: 206-992-6480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60864282
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: