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General NPI Number Information
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NPI Number | 1720447147
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Entity Type | Organization
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Legal Business Name | DR. MONICA A. DAVENPORT, DDS APC
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 1850 MARTIN LUTHER KING DR.
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City | SHREVEPORT
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State | LA
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Zip | 71107-5020
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Country | US
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Telephone | 318-226-0244
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Fax | 318-226-0282
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Provider Business Mailing Address
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Address Line | 1850 MARTIN LUTHER KING DR.
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City | SHREVEPORT
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State | LA
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Zip | 71107-5020
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Country | US
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Telephone | 318-226-0244
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Fax | 318-226-0282
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. MONICA ANNETTE DAVENPORT
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Credential | DDS
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Telephone | 318-226-0244
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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 | 5001
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License Number State | LA
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