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General NPI Number Information
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NPI Number | 1497124556
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Entity Type | Individual
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Provider Name | MARY KATHERINE GAVRI DMD
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Gender | Female
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Dates
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Enumeration Date | 09/18/2015
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 104 W 12TH ST
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City | HOUSTON
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State | TX
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Zip | 77008-6990
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Country | US
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Telephone | 713-861-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 3788 RICHMOND AVE APT 1468
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City | HOUSTON
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State | TX
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Zip | 77046-3719
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Country | US
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Telephone | 757-903-1671
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8545
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8545
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 36717
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License Number State | TX
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