Individual
MARTIN E. AVERILL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2102 KIMBALL AVE, WATERLOO, IA 50702-5037
(319) 233-3506
(319) 233-1335
Mailing address
2102 KIMBALL AVE, WATERLOO, IA 50702-5037
(319) 233-3506
(319) 233-1335
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6316
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0004572
—
IA
Enumeration date
01/18/2007
Last updated
07/08/2007
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