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General NPI Number Information
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NPI Number | 1093887937
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Entity Type | Organization
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Legal Business Name | BRET A. AVRA, DMD, PSC.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2605 KENTUCKY AVE STE #302
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City | PADUCAH
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State | KY
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Zip | 42003-3800
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Country | US
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Telephone | 270-443-1717
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Fax | 270-443-0517
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Provider Business Mailing Address
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Address Line | 2605 KENTUCKY AVENUE STE #302
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City | PADUCAH
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State | KY
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Zip | 42003-3801
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Country | US
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Telephone | 270-443-1717
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Fax | 270-443-0517
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRET A AVRA
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Credential | DMD
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Telephone | 270-443-1717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 6283
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License Number State | KY
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