Healthcare Provider Details

I. General information

NPI: 1982529574
Provider Name (Legal Business Name): LESLEY JACOBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E STATE ST
STERLING MI
48659-9548
US

IV. Provider business mailing address

1064 W CEDAR ST
725 E STATE ST MI
48610
US

V. Phone/Fax

Practice location:
  • Phone: 989-873-5152
  • Fax:
Mailing address:
  • Phone: 989-873-5152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: