Provider Demographics
NPI:1588871784
Name:O'FLANAGAN, MAUREEN LOUISE (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:LOUISE
Last Name:O'FLANAGAN
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SE 15TH TER
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-4464
Mailing Address - Country:US
Mailing Address - Phone:954-427-3755
Mailing Address - Fax:
Practice Address - Street 1:201 SE 15TH TER
Practice Address - Street 2:SUITE 105
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-4464
Practice Address - Country:US
Practice Address - Phone:954-427-3755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00115451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650645399OtherTIN