Provider Demographics
NPI:1811871577
Name:DOUGLASS, AVERY (DMD)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:DOUGLASS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8313 N SUMMERHILL LN
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-6914
Mailing Address - Country:US
Mailing Address - Phone:509-496-1003
Mailing Address - Fax:
Practice Address - Street 1:1520 W GARLAND AVE STE A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2613
Practice Address - Country:US
Practice Address - Phone:509-328-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.70020937122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist