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General NPI Number Information
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NPI Number | 1629671425
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Entity Type | Organization
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Legal Business Name | DAVENPORT DENTAL HYGIENE
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Dates
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Enumeration Date | 11/16/2020
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Last Update Date | 11/16/2020
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Provider Practice Location Address
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Address Line | 450 LEWIS ST # 3D
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-7508
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Country | US
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Telephone | 970-585-4424
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5803
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City | PAGOSA SPRINGS
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State | CO
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Zip | 81147-5803
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Country | US
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Telephone | 970-585-4424
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGIENIST
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Name | ELIZABETH CORENE DAVENPORT
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Credential | RDH
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Telephone | 970-585-4424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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