MEDICARE: DR. SEAN MONTAGUE FLYNN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4115	SC

General Provider Information

NPI Number	:	1023163649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN MONTAGUE FLYNN D.M.D.

Provider Business Mailing Address
First Line	:	1100 PULASKI ST
Second Line	:	APT. 815
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3644
Country	:	US
Telephone Number	:	803-608-3549
Fax Number	:

Provider Business Practice Location Address
First Line	:	2007 BROAD RIVER RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-7006
Country	:	US
Telephone Number	:	803-772-3630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	07/08/2007

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