Provider Demographics
NPI:1437775749
Name:M. AVEY & ASSOCIATES NC PC IV
Entity Type:Organization
Organization Name:M. AVEY & ASSOCIATES NC PC IV
Other - Org Name:GOKIDS PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:AVEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:803-650-3068
Mailing Address - Street 1:3121 SPRINGBANK LN STE G
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-3347
Mailing Address - Country:US
Mailing Address - Phone:704-516-2496
Mailing Address - Fax:
Practice Address - Street 1:17214 LANCASTER HWY STE 301
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2093
Practice Address - Country:US
Practice Address - Phone:704-703-2177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10278OtherNC DENTAL LICENSE