Individual
JESSICA L DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
644 W OSHKOSH ST, RIPON, WI 54971-1001
(920) 748-6122
(920) 748-6070
Mailing address
PO BOX 510, RIPON, WI 54971-0510
(920) 748-6122
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5244-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33761900
—
WI
Enumeration date
10/02/2006
Last updated
04/22/2008
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