Individual
DR. CONNIE ANN JACOBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1529 HERITAGE BLVD, WEST SALEM, WI 54669-9404
(608) 786-0900
(608) 786-4418
Mailing address
1529 HERITAGE BLVD, WEST SALEM, WI 54669-9404
(608) 786-0900
(608) 786-4418
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4258-015
WI
Other
Enumeration date
02/28/2007
Last updated
07/08/2007
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