Provider Demographics
NPI:1164528758
Name:AVERETT, DAN MORRISSETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:MORRISSETTE
Last Name:AVERETT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6405
Mailing Address - Country:US
Mailing Address - Phone:919-781-4913
Mailing Address - Fax:
Practice Address - Street 1:2310 MYRON DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-3358
Practice Address - Country:US
Practice Address - Phone:919-782-9516
Practice Address - Fax:919-782-9538
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice