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General NPI Number Information
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NPI Number | 1881712198
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Entity Type | Organization
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Legal Business Name | AVERY ORTHODONTICS PA
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 12171 W PARMER LANE SUITE 102
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City | CEDAR PARK
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State | TX
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Zip | 78613
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Country | US
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Telephone | 512-260-0084
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Fax | 512-260-0353
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Provider Business Mailing Address
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Address Line | 12171 W PARMER LANE SUITE 102
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City | CEDAR PARK
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State | TX
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Zip | 78613
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Country | US
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Telephone | 512-260-0084
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Fax | 512-260-0353
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Authorized Official
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Title or Position | ORTHODONTIST OFFICER OF PA
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Name | DR. BARBARA GAIL O'DONNELL
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Credential | DDS MS
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Telephone | 512-260-0084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 18829
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License Number State | TX
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