Provider Demographics
NPI:1285766139
Name:FLYNN, ALTON (DDS)
Entity type:Individual
Prefix:
First Name:ALTON
Middle Name:
Last Name:FLYNN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2213 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-6967
Mailing Address - Country:US
Mailing Address - Phone:817-558-8765
Mailing Address - Fax:817-645-5273
Practice Address - Street 1:115 HYDE PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-4524
Practice Address - Country:US
Practice Address - Phone:817-645-7201
Practice Address - Fax:817-645-5273
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice