Provider Demographics
NPI:1497855761
Name:DICK B. DAVENPORT, D.D.S., P.C.
Entity Type:Organization
Organization Name:DICK B. DAVENPORT, D.D.S., P.C.
Other - Org Name:DICK B. DAVENPORT, D.D.S. AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-726-9980
Mailing Address - Street 1:1310 JUNCTION DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6511
Mailing Address - Country:US
Mailing Address - Phone:956-726-9980
Mailing Address - Fax:
Practice Address - Street 1:1310 JUNCTION DR
Practice Address - Street 2:SUITE D
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6511
Practice Address - Country:US
Practice Address - Phone:956-726-9980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty