Provider Demographics
NPI:1386929685
Name:FLANNAGAN DENTAL
Entity type:Organization
Organization Name:FLANNAGAN DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREWS
Authorized Official - Last Name:FLANNAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:256-238-8881
Mailing Address - Street 1:1115 CHRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36207-4618
Mailing Address - Country:US
Mailing Address - Phone:256-238-8881
Mailing Address - Fax:256-238-8803
Practice Address - Street 1:1115 CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-4618
Practice Address - Country:US
Practice Address - Phone:256-238-8881
Practice Address - Fax:256-238-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL56191223G0001X
AL28521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty