Provider Demographics
NPI:1144603861
Name:DAVIS, JOCELYN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOCELYN
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOCELYN
Other - Middle Name:R
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4310 LEONARD ST NW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-8447
Mailing Address - Country:US
Mailing Address - Phone:616-453-6323
Mailing Address - Fax:616-453-0012
Practice Address - Street 1:4310 LEONARD ST NW
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-8447
Practice Address - Country:US
Practice Address - Phone:616-453-6323
Practice Address - Fax:616-453-0012
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-30
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021544122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist