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General NPI Number Information
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NPI Number | 1851278493
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Entity Type | Organization
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Legal Business Name | DAVENPORT PEDIATRIC DENTISTRY, PLLC
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Dates
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Enumeration Date | 08/18/2025
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 2592 JACKS RD
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City | DAVENPORT
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State | FL
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Zip | 33897-8007
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Country | US
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Telephone | 863-866-0014
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Fax |
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Provider Business Mailing Address
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Address Line | 2592 JACKS RD
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City | DAVENPORT
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State | FL
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Zip | 33897-8007
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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 | MEMBER
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Name | LATOYA JONES DOUGLAS
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Credential | DMD
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Telephone | 863-866-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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