| Jack a Davidson DDS MD PLLC | |
|
16141 Fishhawk Blvd Ste B Lithia FL 33547-4380 | |
| (813) 571-1516 | |
| (813) 571-1626 |
| Full Name | Jack a Davidson DDS MD PLLC |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 16141 Fishhawk Blvd Ste B, Lithia, Florida |
| Authorized Official Name and Position | Jack Davidson (DOCTOR) |
| Authorized Official Contact | 8135711516 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack a Davidson DDS MD PLLC 16141 Fishhawk Blvd Ste B Lithia FL 33547-4380 Ph: (813) 571-1516 | Jack a Davidson DDS MD PLLC 16141 Fishhawk Blvd Ste B Lithia FL 33547-4380 Ph: (813) 571-1516 |
| NPI Number | 1548403314 |
|---|---|
| Provider Enumeration Date | 04/09/2009 |
| Last Update Date | 07/09/2025 |
| Certification Date | 07/09/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548403314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 10794 (Maryland) | Primary |
| 2086S0122X | Surgery - Plastic And Reconstructive Surgery | ME72794 (Florida) | Secondary |
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