Provider Demographics
NPI:1902121155
Name:SEDRO-WOOLLEY FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:SEDRO-WOOLLEY FAMILY DENTAL CENTER
Other - Org Name:GLYN A. FLEURY DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLEURY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS (DENTIST)
Authorized Official - Phone:360-855-0351
Mailing Address - Street 1:830 METCALF STREET
Mailing Address - Street 2:
Mailing Address - City:SEDRO-WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284
Mailing Address - Country:US
Mailing Address - Phone:360-855-0351
Mailing Address - Fax:360-855-9357
Practice Address - Street 1:830 METCALF STREET
Practice Address - Street 2:
Practice Address - City:SEDRO-WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284
Practice Address - Country:US
Practice Address - Phone:360-855-0351
Practice Address - Fax:360-855-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA43391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty