Provider Demographics
NPI:1154341030
Name:FLYNN, ROBERT M (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:FLYNN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-2529
Mailing Address - Country:US
Mailing Address - Phone:801-497-0619
Mailing Address - Fax:801-497-0316
Practice Address - Street 1:206 S MAIN ST
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-2529
Practice Address - Country:US
Practice Address - Phone:801-497-0619
Practice Address - Fax:801-497-0316
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5097188-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice