Provider Demographics
NPI:1730811456
Name:FLANAGAN, FREDERICK JOSEPH JR (DDS)
Entity type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:JOSEPH
Last Name:FLANAGAN
Suffix:JR
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 1:1336 W LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21223-3132
Mailing Address - Country:US
Mailing Address - Phone:443-962-3147
Mailing Address - Fax:
Practice Address - Street 1:325 GAMBRILLS RD
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-1102
Practice Address - Country:US
Practice Address - Phone:410-923-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17522122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist