Provider Demographics
NPI:1841416831
Name:DAVENPORT, CARSON SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARSON
Middle Name:SCOTT
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 1:10710 SIKES PL
Mailing Address - Street 2:SUITE 325
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8181
Mailing Address - Country:US
Mailing Address - Phone:704-708-4201
Mailing Address - Fax:704-708-5958
Practice Address - Street 1:10710 SIKES PL
Practice Address - Street 2:SUITE 325
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-8181
Practice Address - Country:US
Practice Address - Phone:704-708-4201
Practice Address - Fax:704-708-5958
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992019Medicaid