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NPI Code Detail

MEDICARE: DR. DAN MORRISSETTE AVERETT D.D.S.

MEDICARE: DR. DAN MORRISSETTE AVERETT D.D.S.
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
11223G0001XGeneral Practice Dentistry3163NC

General Provider Information

NPI Number : 1164528758
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAN MORRISSETTE AVERETT D.D.S.
Provider Business Mailing Address
First Line : 323 RAMBLEWOOD DR
Second Line :
City : RALEIGH
State : NC
Zip : 27609-6405
Country : US
Telephone Number : 919-781-4913
Fax Number :
Provider Business Practice Location Address
First Line : 2310 MYRON DR
Second Line :
City : RALEIGH
State : NC
Zip : 27607-3358
Country : US
Telephone Number : 919-782-9516
Fax Number : 919-782-9538
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 07/08/2007

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