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Individual

DR. JACOBI LAZAR LUDWIG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1905 PLAZA DR, EAGAN, MN 55122-2883
(651) 686-6678
(805) 529-0102
Mailing address
217 W LOS ANGELES AVE, MOORPARK, CA 93021-1867
(805) 529-0100

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
63228
CA
1223G0001X
General Practice Dentistry
D12085
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
78420600
MN
Enumeration date
12/08/2006
Last updated
10/07/2014
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