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General NPI Number Information
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NPI Number | 1679658934
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Entity Type | Individual
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Provider Name | JAMIE DAVENPORT DMD
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Gender | Male
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6150 DIAMOND CENTRE CT # 300-2
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City | FORT MYERS
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State | FL
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Zip | 33912-4365
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Country | US
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Telephone | 239-433-4746
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Fax | 239-433-5557
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Provider Business Mailing Address
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Address Line | 7049 MILL RUN CIR
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City | NAPLES
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State | FL
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Zip | 34109-7214
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16634
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License Number State | FL
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