Individual
DR. MARY JACOB
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
334 BROADWAY, REVERE, MA 02151-5016
(178) 162-9624
Mailing address
99 FLORENCE STREET, APT 102, MALDEN, MA 02148
(203) 548-1113
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1857754
MA
Other
Enumeration date
09/27/2017
Last updated
09/27/2017
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