Stephanie A Avery, RDH – Dental Hygienist

Key facts

NPI: 1356946404
Entity type: Individual (NPI type 1)
Primary specialty: Dental Hygienist 124Q00000X
License: DH12491 (FL)
Practice address: 1166 SW Main Blvd
Lake City, FL 32025-5780
Phone: (386) 752-7373
Fax: (386) 487-1265
NPI assigned: Dec 4, 2020
Sex: Female
Sole proprietor: Yes

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Coast Dental P.a. Dentist · Lake City, FL · NPI 1760058093

NPD
Coast Dental P.a. Dentist · Tampa, FL · NPI 1992803860

NPD (past)

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
DH12491	FL	MD	Dental Hygienist

Practice roles

Organization	Specialty	Status	New patients
Coast Dental P.a.		Current since Jun 22, 2021	Accepting new patients
Coast Dental P.a.		Past since Dec 6, 2020	Accepting new patients

Locations

1166 SW Main Blvd
Lake City, FL 32025
Phone (386) 752-7373

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dental Hygienist	124Q00000X	DH12491	FL	Yes

Addresses

Primary practice location

1166 SW Main Blvd
Lake City, FL 32025-5780

Mailing address

1166 SW Main Blvd
Lake City, FL 32025-5780
Phone (867) 527-3733

Other providers in Lake City, FL

All providers in Lake City, FL · Dental Hygienist in Florida

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2020. 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.

Verify at the official NPI Registry.