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NPI Code Detail

MEDICARE: DR. MELISSA FLYNN D.D.S

MEDICARE: DR. MELISSA FLYNN D.D.S
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
1122300000XDentist3094OH
2122300000XDentistDN20525FL
3122300000XDentistDB-2024-0097NM

General Provider Information

NPI Number : 1063773513
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MELISSA FLYNN D.D.S
Provider Business Mailing Address
First Line : 6401 S RICHARDS AVE
Second Line :
City : SANTA FE
State : NM
Zip : 87508-4887
Country : US
Telephone Number : 505-982-4425
Fax Number :
Provider Business Practice Location Address
First Line : 6401 S RICHARDS AVE
Second Line :
City : SANTA FE
State : NM
Zip : 87508-4887
Country : US
Telephone Number : 505-982-4425
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2012
Last Update Date : 09/06/2024

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