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General NPI Number Information
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NPI Number | 1093411407
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Entity Type | Organization
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Legal Business Name | KEITH BRYAN FLYNN DMD PA
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Dates
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Enumeration Date | 02/07/2023
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | 504 ST. JAMES AVE.
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City | GOOSE CREEK
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State | SC
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Zip | 29445-2793
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Country | US
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Telephone | 843-797-0782
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Fax | 843-797-0954
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Provider Business Mailing Address
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Address Line | 504 ST. JAMES AVE.
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City | GOOSE CREEK
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State | SC
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Zip | 29445-2793
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Country | US
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Telephone | 843-797-0782
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Fax | 843-797-0954
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. KEITH BRYAN FLYNN
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Credential | DMD
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Telephone | 843-797-0782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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