MEDICARE: MICHELLE ANNE FLANIGAN 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	1223P0221X	Pediatric Dentistry	051600	NY

General Provider Information

NPI Number	:	1619905346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANNE FLANIGAN D.M.D.

Provider Business Mailing Address
First Line	:	730 STAFFORD AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-2440
Country	:	US
Telephone Number	:	347-204-0848
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 BRIDGETOWN ST
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-6006
Country	:	US
Telephone Number	:	718-761-7316
Fax Number	:

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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