Provider Demographics
NPI:1366593568
Name:G. GRAY FLYNN, DMD, PA
Entity type:Organization
Organization Name:G. GRAY FLYNN, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:G.
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:FLYNN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-282-5025
Mailing Address - Street 1:2468 BLANDING BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-5193
Mailing Address - Country:US
Mailing Address - Phone:904-282-5025
Mailing Address - Fax:
Practice Address - Street 1:2468 BLANDING BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-5193
Practice Address - Country:US
Practice Address - Phone:904-282-5025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 8514261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental