Individual
BRET A AVRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D,M.D.
Contact information
Practice address
2605 KENTUCKY AVE, STE #302, PADUCAH, KY 42003-3800
(270) 443-1717
(270) 443-0517
Mailing address
2605 KENTUCKY AVE, STE #302, PADUCAH, KY 42003-3800
(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
—
37-1469385
TAX ID
KY
01
—
560132
UNITED CONCORDIA
KY
Enumeration date
08/09/2006
Last updated
10/21/2015
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