Provider Demographics
NPI:1396271003
Name:FLYNN, JOSEPHINE (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPHINE
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3908 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3819
Mailing Address - Country:US
Mailing Address - Phone:631-404-5366
Mailing Address - Fax:
Practice Address - Street 1:11416 SHELBYVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1306
Practice Address - Country:US
Practice Address - Phone:502-245-8442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10750122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD0000Medicare UPIN