Provider Demographics
NPI:1861761132
Name:FLYNN, GEORGE GRAY (DMD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:GRAY
Last Name:FLYNN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist