Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 10684 | MI |
NPI | 1114967296 |
---|---|
Provider Name | Dr. Allan Jacobs |
First Address | Waterford, MI 48328-2761 |
Second Address | Waterford, MI 48328-2761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 08/07/2007 |