Healthcare Provider Details

I. General information

NPI: 1548953870
Provider Name (Legal Business Name): AVANA L STORY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 E DIXON BLVD
SHELBY NC
28152-6840
US

IV. Provider business mailing address

400 E BROOKLYN VILLAGE AVE UNIT 1506
CHARLOTTE NC
28202-3632
US

V. Phone/Fax

Practice location:
  • Phone: 704-284-5174
  • Fax:
Mailing address:
  • Phone: 404-558-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13954
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: