Provider Demographics
NPI:1437245248
Name:DAVENPORT, DERON MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DERON
Middle Name:MICHAEL
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 1:2300 N CRAYCROFT RD
Mailing Address - Street 2:SUITE #3
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2808
Mailing Address - Country:US
Mailing Address - Phone:520-886-2546
Mailing Address - Fax:520-290-9410
Practice Address - Street 1:2300 N CRAYCROFT RD
Practice Address - Street 2:SUITE #3
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2808
Practice Address - Country:US
Practice Address - Phone:520-886-2546
Practice Address - Fax:520-290-9410
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice