Provider Demographics
NPI:1841318110
Name:DAVENPORT & DAVENPORT, PLLC
Entity type:Organization
Organization Name:DAVENPORT & DAVENPORT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-886-2546
Mailing Address - Street 1:2300 N CRAYCROFT RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2808
Mailing Address - Country:US
Mailing Address - Phone:520-886-2546
Mailing Address - Fax:520-290-9410
Practice Address - Street 1:2300 N CRAYCROFT RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2808
Practice Address - Country:US
Practice Address - Phone:520-886-2546
Practice Address - Fax:520-290-9410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ54261223G0001X
AZ17701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty