Individual
DR. JORDAN LEIGH DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
225 W FULTON ST, EDGERTON, WI 53534-1865
(608) 884-9448
Mailing address
621 N PAGE ST, STOUGHTON, WI 53589-1432
(608) 436-1595
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
1001620
WI
1223G0001X
General Practice Dentistry
Primary
1001620
WI
Other
Enumeration date
06/26/2017
Last updated
12/06/2021
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