MEDICARE: DR. JOSEPHINE 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	10750	KY

General Provider Information

NPI Number	:	1396271003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPHINE FLYNN D.M.D.

Provider Business Mailing Address
First Line	:	3908 WINCHESTER RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-3819
Country	:	US
Telephone Number	:	631-404-5366
Fax Number	:

Provider Business Practice Location Address
First Line	:	11416 SHELBYVILLE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40243-1306
Country	:	US
Telephone Number	:	502-245-8442
Fax Number	:

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

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	01/04/2023

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