Provider Demographics
NPI:1497124556
Name:GAVRI, MARY KATHERINE (DMD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:KATHERINE
Last Name:GAVRI
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 1:3788 RICHMOND AVE APT 1468
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-3719
Mailing Address - Country:US
Mailing Address - Phone:757-903-1671
Mailing Address - Fax:
Practice Address - Street 1:104 W 12TH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-6990
Practice Address - Country:US
Practice Address - Phone:713-861-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC85451223G0001X, 1223X0400X
TX367171223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice