# JACK A DAVIDSON DDS MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548403314
- **Authorized official:** DR. JACK DAVIDSON JR. D.D.S, MD (DOCTOR)
- **Authorized official phone:** (813) 571-1516

## Contact information

- **Practice address:** 16141 FISHHAWK BLVD STE B, LITHIA, FL 33547-4380
- **Practice address phone:** (813) 571-1516
- **Practice address fax:** (813) 571-1626
- **Mailing address:** 16141 FISHHAWK BLVD STE B, LITHIA, FL 33547-4380
- **Mailing address phone:** (813) 571-1516
- **Mailing address fax:** (813) 571-1626

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 10794 | MD | Yes |
| 2086S0122X | Plastic and Reconstructive Surgery Physician | ME72794 | FL | — |

## Other

- **Enumeration date:** 04/09/2009
- **Last updated:** 07/09/2025