MEDICARE: KAREN DOREEN AVEY RDH, MSDH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist	0402002522	VA

General Provider Information

NPI Number	:	1164191136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN DOREEN AVEY RDH, MSDH

Provider Business Mailing Address
First Line	:	202 MILL RACE DR
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22602-6931
Country	:	US
Telephone Number	:	540-533-5024
Fax Number	:

Provider Business Practice Location Address
First Line	:	202 MILL RACE DR
Second Line	:
City	:	WINCHESTER
State	:	VA
Zip	:	22602-6931
Country	:	US
Telephone Number	:	540-533-5024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2021
Last Update Date	:	09/12/2021

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