Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack a Davidson DDS MD PLLC

Organization Oral and Maxillofacial Surgery (Dentist) · NPI 1548403314

Jack a Davidson DDS MD PLLC is an Oral and Maxillofacial Surgery (Dentist) in Lithia, Florida. Licensed in Florida and Maryland. Registered with an NPI since 2009.

Licensed in
FL, MD
In the registry since
2009
Specialties on file
2
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

16141 Fishhawk Blvd Ste B
Lithia, FL 33547-4380
Phone: (813) 571-1516
Fax: (813) 571-1626
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral and Maxillofacial Surgery (Dentist) (primary) Taxonomy 1223S0112X · Licence 10794 (MD)
Plastic and Reconstructive Surgery Physician Taxonomy 2086S0122X · Licence ME72794 (FL)

Record details

NPI number1548403314
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Jack Davidson — Doctor · (813) 571-1516
NPI enumeratedApril 9, 2009
Last updated in NPPESJuly 9, 2025
Certification dateJuly 9, 2025
Mailing address16141 Fishhawk Blvd Ste B, Lithia, FL 33547-4380

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