Provider Demographics
NPI:1437210374
Name:FLOWER, GARY ALAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:ALAN
Last Name:FLOWER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2501 LAKERIDGE DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2558
Mailing Address - Country:US
Mailing Address - Phone:402-644-4452
Mailing Address - Fax:402-644-4454
Practice Address - Street 1:2501 LAKERIDGE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2558
Practice Address - Country:US
Practice Address - Phone:402-644-4452
Practice Address - Fax:402-644-4454
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE58931223S0112X
SDM7931223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47080818500Medicaid
SD7809990Medicaid
SD100767Medicare ID - Type Unspecified
SD7809990Medicaid
T95557Medicare UPIN