Provider Demographics
NPI:1497764096
Name:PHUCAS DAVENPORT, FALINE
Entity Type:Individual
Prefix:DR
First Name:FALINE
Middle Name:
Last Name:PHUCAS DAVENPORT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13940 SHELTER MANOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-6226
Mailing Address - Country:US
Mailing Address - Phone:703-753-3001
Mailing Address - Fax:
Practice Address - Street 1:7521 VIRGINIA OAKS DR STE 230
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3831
Practice Address - Country:US
Practice Address - Phone:703-754-7151
Practice Address - Fax:703-754-1784
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014107201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice