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General NPI Number Information
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NPI Number | 1619144524
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Entity Type | Organization
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Legal Business Name | DENISE R. FLYNN DDS LTD
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 05/09/2008
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Provider Practice Location Address
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Address Line | 7310 N VILLA LAKE DR SUITE C
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City | PEORIA
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State | IL
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Zip | 61614-8267
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Country | US
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Telephone | 309-683-2660
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Fax |
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Provider Business Mailing Address
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Address Line | 7310 N VILLA LAKE DR SUITE C
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City | PEORIA
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State | IL
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Zip | 61614-8267
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Country | US
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Telephone | 309-683-2660
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DENISE R FLYNN
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Credential | DDS MS
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Telephone | 309-346-5140
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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 | 021001854
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License Number State | IL
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