Provider Demographics
NPI:1306055801
Name:PURVIS, FLYNT GILBERT (DMD)
Entity type:Individual
Prefix:DR
First Name:FLYNT
Middle Name:GILBERT
Last Name:PURVIS
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 1:2401 DOLLY RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:VESTAVIA
Mailing Address - State:AL
Mailing Address - Zip Code:35243-4609
Mailing Address - Country:US
Mailing Address - Phone:205-983-8980
Mailing Address - Fax:205-983-8982
Practice Address - Street 1:2401 DOLLY RIDGE RD
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35243-4609
Practice Address - Country:US
Practice Address - Phone:205-983-8980
Practice Address - Fax:205-983-8982
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131801223P0221X, 1223P0221X
AL56071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA355630Medicaid