Provider Demographics
NPI:1689080764
Name:AVERY, DAVID B (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:AVERY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 PEACH ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-3505
Mailing Address - Country:US
Mailing Address - Phone:706-798-6720
Mailing Address - Fax:
Practice Address - Street 1:3041 PEACH ORCHARD RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-3505
Practice Address - Country:US
Practice Address - Phone:706-798-6720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist