Jessica L Davis, D.D.S.
Individual provider Active NPI General Practice Dentistry · Ripon, WI
NPI 1619060795 · NPPES record last updated Apr 22, 2008
Key facts
- NPI
- 1619060795
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 5244-015 (WI)
- Practice address
- 644 W Oshkosh St
Ripon, WI 54971-1001 - Phone
- (920) 748-6122
- Fax
- (920) 748-6070
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150424002294 | WI | Order and Referring Only - Oral Surgery |
1052630019 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5244-015 | WI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hillside Dental Associates | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 5244-015 | WI | Yes |
Addresses
Primary practice location
644 W Oshkosh St
Ripon, WI 54971-1001
Mailing address
PO Box 510
Ripon, WI 54971-0510
Phone (920) 748-6122
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33761900 | Medicaid | WI |
Other providers in Ripon, WI
- Consultants Laboratory of Wisconsin, LLC
- Cooperleaf Management Group
- Katelynn Coughlin
- Danielle M Covach
- John Dalsbo
- Eric Demshar
- Glenn F. Devries
- Diverse Options, Inc.
- David N Duehring
- Mark S Edinger
All providers in Ripon, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.