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General NPI Number Information
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NPI Number | 1699438028
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Entity Type | Organization
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Legal Business Name | DAVID JACOBS DDS PLLC
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Dates
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Enumeration Date | 10/21/2021
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Last Update Date | 10/21/2021
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Provider Practice Location Address
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Address Line | 24101 GREATER MACK AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1409
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Country | US
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Telephone | 586-774-2400
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Fax |
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Provider Business Mailing Address
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Address Line | 24101 GREATER MACK AVE
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City | SAINT CLAIR SHORES
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State | MI
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Zip | 48080-1409
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Country | US
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Telephone | 586-774-2400
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Fax |
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Authorized Official
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Title or Position | OWNER, DENTIST
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Name | DR. DAVID JACOBS
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Credential | DDS
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Telephone | 248-703-8944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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