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General NPI Number Information
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NPI Number | 1215259700
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Entity Type | Individual
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Provider Name | HOMAIRA AVENDANO D.D.S
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Gender | Female
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Dates
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Enumeration Date | 02/24/2010
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Last Update Date | 07/22/2019
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Provider Practice Location Address
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Address Line | 1797 N ELM ST
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City | COMMERCE
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State | GA
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Zip | 30529-2351
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Country | US
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Telephone | 706-335-5501
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Fax |
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Provider Business Mailing Address
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Address Line | 1797 N ELM ST
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City | COMMERCE
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State | GA
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Zip | 30529-2351
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Country | US
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Telephone | 706-335-5501
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28333
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019027951
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 60736
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License Number State | KS
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 015325
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License Number State | GA
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