Provider Demographics
NPI:1407243173
Name:DAVENPORT DENTAL, LLC
Entity Type:Organization
Organization Name:DAVENPORT DENTAL, LLC
Other - Org Name:MARKHAM STREET DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:501-666-7623
Mailing Address - Street 1:10220 W MARKHAM ST
Mailing Address - Street 2:STE 101
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2189
Mailing Address - Country:US
Mailing Address - Phone:501-666-7623
Mailing Address - Fax:501-666-3410
Practice Address - Street 1:10220 W MARKHAM ST
Practice Address - Street 2:STE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2189
Practice Address - Country:US
Practice Address - Phone:501-666-7623
Practice Address - Fax:501-666-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-21
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty