Provider Demographics
NPI:1689814790
Name:DAVENPORT FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:DAVENPORT FAMILY DENTISTRY, LLC
Other - Org Name:COVINGTON DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:985-892-2273
Mailing Address - Street 1:604 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3346
Mailing Address - Country:US
Mailing Address - Phone:985-892-2273
Mailing Address - Fax:985-892-2579
Practice Address - Street 1:604 S TYLER ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-3346
Practice Address - Country:US
Practice Address - Phone:985-892-2273
Practice Address - Fax:985-892-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5713261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental