Provider Demographics
NPI:1174675771
Name:MURAV, AVERY JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:AVERY
Middle Name:JAY
Last Name:MURAV
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 1:6330 ORCHARD LAKE ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322
Mailing Address - Country:US
Mailing Address - Phone:248-932-0550
Mailing Address - Fax:248-932-5479
Practice Address - Street 1:6330 ORCHARD LAKE ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322
Practice Address - Country:US
Practice Address - Phone:248-932-0550
Practice Address - Fax:248-932-5479
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist