Provider Demographics
NPI:1134311830
Name:DR. KEITH B. FLYNN DMD PA
Entity type:Organization
Organization Name:DR. KEITH B. FLYNN DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-824-8742
Mailing Address - Street 1:1505 RED BANK RD
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-4516
Mailing Address - Country:US
Mailing Address - Phone:843-824-8742
Mailing Address - Fax:843-824-8430
Practice Address - Street 1:1505 RED BANK RD
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-4516
Practice Address - Country:US
Practice Address - Phone:843-824-8742
Practice Address - Fax:843-824-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty