Clarence Renshaw Avery, D.D.S.
Individual provider Active NPI Dentist · Pascagoula, MS
NPI 1487769055 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1487769055
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 1819-78 (MS)
- Practice address
- 5106 Telephone Rd
Pascagoula, MS 39567-1120 - Phone
- (228) 762-9123
- Fax
- (228) 762-9123
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1819-78 | MS | Yes |
Addresses
Primary practice location
5106 Telephone Rd
Pascagoula, MS 39567-1120
Mailing address
PO Box 405
Pascagoula, MS 39568-0405
Phone (228) 762-9123
Other providers in Pascagoula, MS
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.