Healthcare Provider Details

I. General information

NPI: 1376975250
Provider Name (Legal Business Name): JACOB ISAAC IHLE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1409 COLLEGE WAY
FERGUS FALLS MN
56537-1055
US

IV. Provider business mailing address

1409 COLLEGE WAY
FERGUS FALLS MN
56537-1055
US

V. Phone/Fax

Practice location:
  • Phone: 218-739-3245
  • Fax:
Mailing address:
  • Phone: 218-365-3145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD13307
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: