Jack a Davidson DDS MD PLLC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

10794 Issued in MD

Legal business name

JACK A DAVIDSON DDS MD PLLC

Practice address

16141 Fishhawk Blvd Ste B
Lithia, FL 33547-4380

Phone

(813) 571-1516

Fax

(813) 571-1626

NPI assigned

Apr 9, 2009

Last updated

Jul 9, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jack Davidson Jr., D.D.S, MDNPI 1831289099

Title

Doctor

Phone

(813) 571-1516

Specialties & licenses 2

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack Allen Davidson Jr., DDS, MD

  • Oral and Maxillofacial Surgery (Dentist)
  • Lithia, FL
  • NPI 1831289099
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752019200000",
    "number": "1548403314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16141 FISHHAWK BLVD STE B",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335474380",
            "telephone_number": "813-571-1516",
            "fax_number": "813-571-1626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16141 FISHHAWK BLVD STE B",
            "city": "LITHIA",
            "state": "FL",
            "postal_code": "335474380",
            "telephone_number": "813-571-1516",
            "fax_number": "813-571-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK A DAVIDSON DDS MD PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-09",
        "last_updated": "2025-07-09",
        "certification_date": "2025-07-09",
        "status": "A",
        "authorized_official_last_name": "DAVIDSON",
        "authorized_official_first_name": "JACK",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "813-571-1516",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "D.D.S, MD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MD",
            "license": "10794",
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "FL",
            "license": "ME72794",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eunice Ikpekpe
• Cassandra Ingraham
• Amber Irvin, BCBA
• J Paky Horizons (FishHawk Behavior Management)
• J.C.Barrios M.D LLC
• Tiffany Terryll James, PHARMD
• Jacqueline Irene Jancek, CLC
• Megan Jarvis
• Ashley Jasenec, PHARMD
• Nadine Krystal Jean-Baptiste, DMD

• Oral and Maxillofacial Surgery (Dentist) in Lithia, FL
• Providers in Lithia, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.