Jordan Leigh Davis, DDS – General Practice Dentistry

Key facts

NPI: 1982124541
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 1001620 (WI)
Practice address: 225 W Fulton St
Edgerton, WI 53534-1865
Phone: (608) 884-9448
NPI assigned: Jun 26, 2017
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

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

Janesvillectd LLC Dentist · Janesville, WI · NPI 1508533621

NPD (past) DENTIST

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
1001620	WI	MD	General Practice Dentistry

Practice roles

Organization	Specialty	Status	New patients
Janesvillectd LLC	Dentist	Past since Aug 29, 2021	Accepting new patients

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	1001620	WI
General Practice Dentistry	1223G0001X	1001620	WI	Yes

Addresses

Primary practice location

225 W Fulton St
Edgerton, WI 53534-1865

Mailing address

621 N Page St
Stoughton, WI 53589-1432
Phone (608) 436-1595

Other practice location 1

1111 Suffolk Dr
Janesville, WI 53546-1608
Phone (608) 752-6848

Other providers in Edgerton, WI

All providers in Edgerton, 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 Dec 6, 2021. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.