# DENTISTS OF DAVENPORT, PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DENTISTS OF DAVENPORT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073381521
- **Authorized official:** OMEIR TARIQ ANSARI DDS (OWNER)
- **Authorized official phone:** (863) 812-4570

## Contact information

- **Practice address:** 2122 TRIGLIA WAY, DAVENPORT, FL 33896
- **Practice address phone:** (863) 812-4570
- **Practice address fax:** (863) 812-4219
- **Mailing address:** PO BOX 920050, DALLAS, TX 75392-0050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | NULL | Yes |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 12/14/2023
- **Last updated:** 12/14/2023