Provider Demographics
NPI:1952467805
Name:DAVID B AVERY, DMD, PC
Entity Type:Organization
Organization Name:DAVID B AVERY, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:706-798-6720
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:706-798-6130
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:706-798-6130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty