Provider Demographics
NPI:1891073557
Name:DAVENPORT, JAMES MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
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 1:8 WOODBERRY RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212-2742
Mailing Address - Country:US
Mailing Address - Phone:501-912-3487
Mailing Address - Fax:
Practice Address - Street 1:10220 W MARKHAM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2189
Practice Address - Country:US
Practice Address - Phone:501-666-7623
Practice Address - Fax:501-666-3410
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist