Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 0401005717 | VA |
NPI | 1093798696 |
---|---|
Provider Name | Dr. William L Davenport |
First Address | Hampton, VA 23661-3440 |
Second Address | Hampton, VA 23666-5903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009509 | DORAL DENTAL (01) | VA |
441659 | ANTHEM (01) | VA |
584223 | UNITED CONCORDIA (01) | VA |
8000174 | (05) | VA |
U-87431 | (02) |