Healthcare Provider Details

I. General information

NPI: 1225443757
Provider Name (Legal Business Name): KATHARINE BUNKE DAVENPORT D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2014
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 COMANCHE ST
KIOWA CO
80117-5080
US

IV. Provider business mailing address

15230 CHURCHILL PL
COLORADO SPRINGS CO
80921-2598
US

V. Phone/Fax

Practice location:
  • Phone: 720-389-9763
  • Fax:
Mailing address:
  • Phone: 651-230-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number00202564
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00202564
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: