Provider Demographics
NPI:1023221488
Name:SEAN P. AVERA D.D.S., INC.
Entity Type:Organization
Organization Name:SEAN P. AVERA D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:AVERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:530-885-0953
Mailing Address - Street 1:3113 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2459
Mailing Address - Country:US
Mailing Address - Phone:530-885-0953
Mailing Address - Fax:530-885-2980
Practice Address - Street 1:3113 PROFESSIONAL DR
Practice Address - Street 2:SUITE 5
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2459
Practice Address - Country:US
Practice Address - Phone:530-885-0953
Practice Address - Fax:530-885-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty