Provider Demographics
NPI:1396811212
Name:FLYNN, DONALD GEORGE (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GEORGE
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 1:1177 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-2281
Mailing Address - Country:US
Mailing Address - Phone:630-801-1496
Mailing Address - Fax:
Practice Address - Street 1:1177 N HIGHLAND AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-2281
Practice Address - Country:US
Practice Address - Phone:630-801-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0300XDental ProvidersDentistPeriodontics