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Organization

JACK A DAVIDSON DDS MD PLLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JACK DAVIDSON JR. D.D.S, MD (DOCTOR)
(813) 571-1516
Entity
Organization

Contact information

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

Taxonomy

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

Other

Enumeration date
04/09/2009
Last updated
07/09/2025
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