Provider Demographics
NPI:1932266640
Name:FLEURY, GLYN ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:GLYN
Middle Name:ANTHONY
Last Name:FLEURY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3106FLOtherREGENCE
WA169600OtherDEPT LABOR & INDUSTRIES
WA5373105Medicaid
759311OtherUNITED CONCORDIA