Healthcare Provider Details

I. General information

NPI: 1720316789
Provider Name (Legal Business Name): KENT J DAVENPORT BC HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2009
Last Update Date: 12/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 RENAISSANCE DR STE A
LAS VEGAS NV
89119-6194
US

IV. Provider business mailing address

2255 RENAISSANCE DR STE A
LAS VEGAS NV
89119-6194
US

V. Phone/Fax

Practice location:
  • Phone: 702-369-1321
  • Fax: 702-798-4865
Mailing address:
  • Phone: 702-369-1321
  • Fax: 702-798-4865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number66
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: