Provider Demographics
NPI:1902359565
Name:AVEY, MARTIN C (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:C
Last Name:AVEY
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 MAIN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4200 MAIN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7484
Practice Address - Country:US
Practice Address - Phone:704-454-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics