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General NPI Number Information
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NPI Number | 1013140441
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Entity Type | Individual
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Provider Name | CHARLES MICHAEL FLINT D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2009
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Last Update Date | 11/24/2020
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Provider Practice Location Address
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Address Line | 430 N HIGH ST
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City | HENDERSON
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State | TX
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Zip | 75652-5910
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Country | US
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Telephone | 918-760-5074
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Fax | 903-657-1551
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Provider Business Mailing Address
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Address Line | 430 N HIGH ST
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City | HENDERSON
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State | TX
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Zip | 75652-5910
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Country | US
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Telephone | 918-760-5074
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 34701
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6103
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License Number State | OK
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