Martin E. Averill, D.D.S.
Individual provider Active NPI General Practice Dentistry · Waterloo, IA
NPI 1043363757 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043363757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6316 (IA)
- Practice address
- 2102 Kimball Ave
Waterloo, IA 50702-5037 - Phone
- (319) 233-3506
- Fax
- (319) 233-1335
- NPI assigned
- Jan 18, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6316 | IA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6316 | IA | Yes |
Addresses
Primary practice location
2102 Kimball Ave
Waterloo, IA 50702-5037
Mailing address
2102 Kimball Ave
Waterloo, IA 50702-5037
Phone (319) 233-3506
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0004572 | Medicaid | IA |
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All providers in Waterloo, IA · General Practice Dentistry in Iowa
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.