Individual
JONATHAN JACOBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1411 S RANGE LINE RD, JOPLIN, MO 64801-5589
(417) 553-7377
(417) 553-7293
Mailing address
1411 S RANGE LINE RD, JOPLIN, MO 64801-5589
(417) 553-7377
(417) 553-7293
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2015016758
MO
Other
Enumeration date
06/29/2015
Last updated
06/29/2015
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