Healthcare Provider Details

I. General information

NPI: 1437210374
Provider Name (Legal Business Name): GARY ALAN FLOWER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 LAKERIDGE DRIVE SUITE 100
NORFOLK NE
68701-2558
US

IV. Provider business mailing address

2501 LAKERIDGE DRIVE SUITE 100
NORFOLK NE
68701-2558
US

V. Phone/Fax

Practice location:
  • Phone: 402-644-4452
  • Fax: 402-644-4454
Mailing address:
  • Phone: 402-644-4452
  • Fax: 402-644-4454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5893
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberM793
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: