=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811871577
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AVERY DOUGLASS DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2025
-----------------------------------------------------
Last Update Date | 08/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1520 W GARLAND AVE STE A
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99205-2613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-328-9787
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8313 N SUMMERHILL LN
-----------------------------------------------------
City | SPOKANE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 99208-6914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-496-1003
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DENT.DE.70020937
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------