Organization
BRET A. AVRA, DMD, PSC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRET A AVRA DMD (PRESIDENT)
(270) 443-1717
Entity
Organization
Contact information
Practice address
2605 KENTUCKY AVE, STE #302, PADUCAH, KY 42003-3800
(270) 443-1717
(270) 443-0517
Mailing address
2605 KENTUCKY AVENUE, STE #302, PADUCAH, KY 42003-3801
(270) 443-1717
(270) 443-0517
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
6283
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000316468
ANTHEM BCBS KY
KY
01
—
560132
UNITED CONCORDIA
KY
Enumeration date
11/15/2006
Last updated
08/22/2020
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