MEDICARE: DIVINE DENTAL ANNAPOLIS

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

General Provider Information

NPI Number	:	1821930108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE DENTAL ANNAPOLIS

Provider Business Mailing Address
First Line	:	4801 RITCHIE HWY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21225-3045
Country	:	US
Telephone Number	:	410-789-5228
Fax Number	:	410-789-2162

Provider Business Practice Location Address
First Line	:	37 OLD SOLOMONS ISLAND RD STE 1
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3985
Country	:	US
Telephone Number	:	410-224-4411
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	FREDERICK J FLANAGAN II
Credential	:	DDS
Telephone Number	:	410-789-5228

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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Directions to “DIVINE DENTAL ANNAPOLIS ” Practice Location

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