Active NPI
Glyn Anthony Fleury, DDS
- Dentist
- Sedro Woolley, WA
National Provider Identifier
1932266640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 4339
- Practice address
- 830 Metcalf Street
Sedro Woolley, WA 98284 - Phone
- (360) 855-0351
- Fax
- (360) 855-9357
- NPI assigned
- Jan 2, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 4339 | WA | Primary |
Addresses
Primary practice location
830 Metcalf Street
Sedro Woolley, WA 98284
Mailing address
830 Metcalf Street
Sedro Woolley, WA 98284
Phone (360) 855-0351
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3106FL | Other | WA | REGENCE |
| 169600 | Other | WA | DEPT LABOR & INDUSTRIES |
| 5373105 | Medicaid | WA | |
| 759311 | Other | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4339 | WA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sedro Woolley Family Dental Center, P.S. | Past | Accepting new patients | |
| Sedro-Woolley Family Dental Center | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Sedro-Woolley, WA
- NPI 1902121155
-
- Dental Clinic/Center
- Sedro Woolley, WA
- NPI 1184963845
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932266640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 METCALF STREET",
"city": "SEDRO WOOLLEY",
"state": "WA",
"postal_code": "98284",
"telephone_number": "360-855-0351",
"fax_number": "360-855-9357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "830 METCALF STREET",
"city": "SEDRO WOOLLEY",
"state": "WA",
"postal_code": "98284",
"telephone_number": "360-855-0351",
"fax_number": "360-855-9357"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLEURY",
"first_name": "GLYN",
"middle_name": "ANTHONY",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "4339",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE",
"identifier": "3106FL",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT LABOR & INDUSTRIES",
"identifier": "169600",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5373105",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "759311",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Sedro Woolley, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.