Provider Demographics
NPI:1043989510
Name:AVERY, SHAYLEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHAYLEE
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 E EAGLE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-7313
Mailing Address - Country:US
Mailing Address - Phone:801-660-9488
Mailing Address - Fax:
Practice Address - Street 1:168 N 1950 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84116-3098
Practice Address - Country:US
Practice Address - Phone:801-587-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1231981499231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice