Individual
DR. JACK ALLEN DAVIDSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
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
208200000X
Plastic Surgery Physician
ME72794
FL
Other
Enumeration date
10/16/2006
Last updated
07/09/2025
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