Provider Demographics
NPI:1558683052
Name:DAVENPORT, THOMAS NAEF (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NAEF
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 1:4225 E MCDOWELL RD APT 2103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7473
Mailing Address - Country:US
Mailing Address - Phone:410-440-9703
Mailing Address - Fax:
Practice Address - Street 1:4225 E MCDOWELL RD APT 2103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-7473
Practice Address - Country:US
Practice Address - Phone:410-440-9703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist