Provider Demographics
NPI:1093798696
Name:DAVENPORT, WILLIAM L (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 CHESAPEAKE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-3440
Mailing Address - Country:US
Mailing Address - Phone:757-722-9229
Mailing Address - Fax:
Practice Address - Street 1:2240 COLISEUM DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5903
Practice Address - Country:US
Practice Address - Phone:757-595-1457
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010057171223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA584223OtherUNITED CONCORDIA
VA8000174Medicaid
VA0009509OtherDORAL DENTAL
VA441659OtherANTHEM
VA584223OtherUNITED CONCORDIA