Avery Nicolette Fain
Individual provider Active NPI Dental Hygienist · Kaufman, TX
NPI 1871345652 · NPPES record last updated Apr 4, 2024
Key facts
- NPI
- 1871345652
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dental Hygienist 124Q00000X
- License
- 25814 (TX)
- Practice address
- 2211 Old Kemp Hwy
Kaufman, TX 75142-3658 - Phone
- (972) 932-4312
- NPI assigned
- Apr 4, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|
| DH.002026962 | CO | MD | Dental Hygienist |
| 25814 | TX | MD | Dental Hygienist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | DH.002026962 | CO | |
| Dental Hygienist | 124Q00000X | 25814 | TX | Yes |
Addresses
Primary practice location
2211 Old Kemp Hwy
Kaufman, TX 75142-3658
Mailing address
2211 Old Kemp Hwy
Kaufman, TX 75142-3658
Phone (972) 932-4312
Other providers in Kaufman, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 4, 2024. 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.