Provider Demographics
NPI:1497765788
Name:AVERY, ROBERT DANIEL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DANIEL
Last Name:AVERY
Suffix:JR
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:PO BOX 369
Mailing Address - Street 2:235-K ST. JOHN RD
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-0369
Mailing Address - Country:US
Mailing Address - Phone:828-654-7450
Mailing Address - Fax:828-654-8665
Practice Address - Street 1:235 ST JOHNS RD STE K
Practice Address - Street 2:235-K ST. JOHN RD
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-8335
Practice Address - Country:US
Practice Address - Phone:828-654-7450
Practice Address - Fax:828-654-8665
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice