Provider Demographics
NPI:1447386537
Name:AVERY, CHRISTOPHER D (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:D
Last Name:AVERY
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 1:127 SOUTH PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023
Mailing Address - Country:US
Mailing Address - Phone:740-587-1136
Mailing Address - Fax:740-587-1137
Practice Address - Street 1:127 SOUTH PROSPECT ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023
Practice Address - Country:US
Practice Address - Phone:740-587-1136
Practice Address - Fax:740-587-1137
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15333122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0406760Medicaid