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General NPI Number Information
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NPI Number | 1922543909
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Entity Type | Organization
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Legal Business Name | AVERY'S CREEK FAMILY DENTISTRY
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 1748 BREVARD RD
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City | ARDEN
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State | NC
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Zip | 28704-9658
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Country | US
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Telephone | 828-676-2114
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Fax |
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Provider Business Mailing Address
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Address Line | 1748 BREVARD RD
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City | ARDEN
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State | NC
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Zip | 28704-9658
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | MELANIE CASEY
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Credential |
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Telephone | 828676211446
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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 | 9335
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License Number State | NC
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