Healthcare Provider Details

I. General information

NPI: 1558683052
Provider Name (Legal Business Name): THOMAS NAEF DAVENPORT D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7405 W GRANDRIDGE BLVD STE B
KENNEWICK WA
99336-6708
US

IV. Provider business mailing address

4225 E MCDOWELL RD APT 2103
PHOENIX AZ
85008-7473
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-8161
  • Fax: 509-783-0327
Mailing address:
  • Phone: 410-440-9703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number100133
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60862695
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: