| NPI | 1568005999 |
|---|---|
| Doing Business As | DAVENPORT MODERN DENTISTRY |
| Entity Type | Organization |
| Authorized Contact | MINH B PHAM Owner/Dds 863-777-9890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2022-06-14 |