=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942386321
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EUGENE PATRICK FLANAGAN JR. DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1827 SW GREEN OAKS BLVD SUITE 169
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76017-7928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-468-8600
-----------------------------------------------------
Fax | 817-419-9791
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1827 SW GREEN OAKS BLVD SUITE 169
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76017-7928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-468-8600
-----------------------------------------------------
Fax | 817-419-9791
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 13081
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------