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NPI Code Detail

MEDICARE: MEGAN DAVENPORT DDS

MEDICARE:   MEGAN  DAVENPORT  DDS
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
11223P0221XPediatric Dentistry019030175IL

General Provider Information

NPI Number : 1962790428
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEGAN DAVENPORT DDS
Provider Business Mailing Address
First Line : 2668 N HALSTED ST APT 202
Second Line :
City : CHICAGO
State : IL
Zip : 60614-7683
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1611 N. WOLCOTT AVE.
Second Line :
City : CHICAGO
State : IL
Zip : 60622-1362
Country : US
Telephone Number : 312-281-4860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2011
Last Update Date : 10/28/2015

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Directions to “ MEGAN DAVENPORT DDS” Practice Location

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