Jordan Leigh Davis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

1001620 Issued in WI

Practice address

225 W Fulton St
Edgerton, WI 53534-1865

Phone

(608) 884-9448

NPI assigned

Jun 26, 2017

Last updated

Dec 6, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Janesvillectd LLC

  • Dentist
  • Janesville, WI
  • NPI 1508533621
  NPD (past)

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1982124541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "621 N PAGE ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535891432",
            "telephone_number": "608-436-1595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 W FULTON ST",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535341865",
            "telephone_number": "608-884-9448"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 Suffolk Dr",
            "address_purpose": "LOCATION",
            "city": "Janesville",
            "state": "WI",
            "postal_code": "535461608",
            "country_code": "US",
            "telephone_number": "608-752-6848",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JORDAN",
        "middle_name": "LEIGH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-26",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "1001620",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "1001620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Richard Connery, LPN
• Cheryl L Connery, RN
• Cassy M Cooley, DPT
• Patrick Kevin Cork, LCSW
• Haley Cottingham, APNP
• Dean Health Systems, Inc. (SSM Health Dean Medical Group - Edgerton)
• Dean Health Systems, Inc.
• Laurie K Drewsen
• Edgerton Chemists Inc. (Edgerton Pharmacy)
• Edgerton Community Schools

• General Practice Dentistry in Edgerton, WI
• Providers in Edgerton, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2021; 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.