Individual
MR. JACK JUSTIN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
543 WEST AVE, RIFLE, CO 81650-3553
(970) 625-1391
(970) 625-9372
Mailing address
543 WEST AVE, RIFLE, CO 81650-3553
(970) 625-1391
(970) 625-9372
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
104954
CO
Other
Enumeration date
08/17/2006
Last updated
07/08/2007
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