Healthcare Provider Details

I. General information

NPI: 1528181252
Provider Name (Legal Business Name): MICHAEL EDWARD FLYNN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 S 109TH ST #300
WEST ALLIS WI
53227-1909
US

IV. Provider business mailing address

2323 S 109TH ST #300
WEST ALLIS WI
53227-1909
US

V. Phone/Fax

Practice location:
  • Phone: 414-541-8250
  • Fax: 414-541-8241
Mailing address:
  • Phone: 414-541-8250
  • Fax: 414-541-8241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3602
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: