Individual
KIRBY L DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
HIGHWAY 178 & 508 HILLCREST, BULL SHOALS, AR 72619
(870) 445-4040
(870) 445-3216
Mailing address
PO BOX 717, BULL SHOALS, AR 72619-0717
(870) 445-4040
(870) 445-3216
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2230
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108534
UNITED CONCORDIA
AR
01
—
58699
BLUE CROSS BLUE SHIELD
AR
01
—
91028000040
QUAL CHOICE
AR
Enumeration date
06/19/2006
Last updated
07/08/2007
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