Provider Demographics
NPI:1225443757
Name:DAVENPORT, KATHARINE BUNKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:BUNKE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15230 CHURCHILL PL
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2598
Mailing Address - Country:US
Mailing Address - Phone:651-230-7228
Mailing Address - Fax:
Practice Address - Street 1:320 COMANCHE ST
Practice Address - Street 2:
Practice Address - City:KIOWA
Practice Address - State:CO
Practice Address - Zip Code:80117-5080
Practice Address - Country:US
Practice Address - Phone:720-389-9763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202564122300000X
CODEN.00202564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist