MEDICARE: DR. THOMAS NAEF DAVENPORT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	100133	CA

General Provider Information

NPI Number	:	1558683052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS NAEF DAVENPORT D.D.S.

Provider Business Mailing Address
First Line	:	4225 E MCDOWELL RD APT 2103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-7473
Country	:	US
Telephone Number	:	410-440-9703
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 E MCDOWELL RD APT 2103
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-7473
Country	:	US
Telephone Number	:	410-440-9703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2010
Last Update Date	:	08/07/2019

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