Healthcare Provider Details

I. General information

NPI: 1518314533
Provider Name (Legal Business Name): DENTON DAVENPORT DO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9140 W. THOMAS ROAD, STE. B-106
PHOENIX AZ
85037
US

IV. Provider business mailing address

10133 N 92ND ST., SUITE 102
SCOTTSDALE AZ
85258
US

V. Phone/Fax

Practice location:
  • Phone: 602-475-5646
  • Fax: 602-277-8146
Mailing address:
  • Phone: 602-475-5646
  • Fax: 602-277-8146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number6600
License Number StateAZ

VIII. Authorized Official

Name: DR. DENTON R DAVENPORT
Title or Position: OWNER
Credential: D.O.
Phone: 602-308-7817