Individual
MARC JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
10521 N PORT WASHINGTON RD, MEQUON, WI 53092-5584
(262) 241-2060
(262) 241-2064
Mailing address
10521 N PORT WASHINGTON RD, MEQUON, WI 53092-5584
(262) 241-2060
(262) 241-2064
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2475-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33412900
—
WI
Enumeration date
06/05/2008
Last updated
06/05/2008
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