MEDICARE: DR. JOCELYN R DAVIS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901021544	MI

General Provider Information

NPI Number	:	1144603861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOCELYN R DAVIS D.D.S.

Provider Business Mailing Address
First Line	:	4310 LEONARD ST NW
Second Line	:	SUITE 202
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-8447
Country	:	US
Telephone Number	:	616-453-6323
Fax Number	:	616-453-0012

Provider Business Practice Location Address
First Line	:	4310 LEONARD ST NW
Second Line	:	SUITE 202
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-8447
Country	:	US
Telephone Number	:	616-453-6323
Fax Number	:	616-453-0012

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2015
Last Update Date	:	06/30/2015

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