John Benjamin Avera, D.D.S.
Individual provider Active NPI Periodontics · Aptos, CA
NPI 1043301609 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043301609
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Periodontics 1223P0300X
- License
- 28900 (CA)
- Practice address
- 9059 Soquel Dr
B
Aptos, CA 95003-4076 - Phone
- (831) 688-1975
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150903002727 | CA | Order and Referring Only - Dentist |
6103132295 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 28900 | CA | Yes |
Addresses
Primary practice location
9059 Soquel Dr
B
Aptos, CA 95003-4076
Mailing address
9059 Soquel Dr
B
Aptos, CA 95003-4076
Phone (831) 688-1975
Other providers in Aptos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.