Provider Demographics
NPI:1407460975
Name:FLINT DENTAL GROUP
Entity type:Organization
Organization Name:FLINT DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JENNINGS DDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:940-206-8956
Mailing Address - Street 1:4324 LAZY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1554
Mailing Address - Country:US
Mailing Address - Phone:903-330-2509
Mailing Address - Fax:
Practice Address - Street 1:17159 FM 2493
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:TX
Practice Address - Zip Code:75762-8331
Practice Address - Country:US
Practice Address - Phone:064-903-8946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental