Charles Michael Flint, D.D.S.
Individual provider Active NPI Dentist · Henderson, TX
NPI 1013140441 · NPPES record last updated Nov 24, 2020
Key facts
- NPI
- 1013140441
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6103 (OK)
- Practice address
- 430 N High St
Henderson, TX 75652-5910 - Phone
- (918) 760-5074
- Fax
- (903) 657-1551
- NPI assigned
- Sep 2, 2009
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34701 | TX | MD | Orthodontics and Dentofacial Orthopedic Dentist |
| 6103 | OK | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wayne N. Wyatt, DDS, Ms, PC | Orthodontics and Dentofacial Orthopedics | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 34701 | TX | |
| Dentist | 122300000X | 6103 | OK | Yes |
Addresses
Primary practice location
430 N High St
Henderson, TX 75652-5910
Mailing address
430 N High St
Henderson, TX 75652-5910
Phone (918) 760-5074
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200455850A | Medicaid | OK |
Other providers in Henderson, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.