Provider Demographics
NPI:1649505769
Name:JONI M. AVERY DDS AUSTIN, P.A.
Entity type:Organization
Organization Name:JONI M. AVERY DDS AUSTIN, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONI
Authorized Official - Middle Name:M
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:512-858-2201
Mailing Address - Street 1:2201 W HWY 290
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3410
Mailing Address - Country:US
Mailing Address - Phone:512-858-2201
Mailing Address - Fax:
Practice Address - Street 1:2201 W HWY 290
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3410
Practice Address - Country:US
Practice Address - Phone:512-858-2201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JONI M. AVERY D.D.S., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20281305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service