Provider Demographics
NPI:1841746633
Name:DAVENPORT FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DAVENPORT FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-725-1181
Mailing Address - Street 1:PO BOX 1312
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:WA
Mailing Address - Zip Code:99122-1312
Mailing Address - Country:US
Mailing Address - Phone:509-725-1181
Mailing Address - Fax:509-725-1182
Practice Address - Street 1:707 LOGAN ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:WA
Practice Address - Zip Code:99122-1312
Practice Address - Country:US
Practice Address - Phone:509-725-1181
Practice Address - Fax:509-725-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7027261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental