Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6103 | OK |
N | 1223X0400X | Orthodontists | 34701 | TX |
NPI | 1013140441 |
---|---|
Provider Name | Dr. Charles Michael Flint |
First Address | Henderson, TX 75652-5910 |
Second Address | Henderson, TX 75652-5910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2009 |
Last Update Date | 24/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200455850A | (05) | OK |