Individual
DR. BRIAN BERNARD JACOBUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS, PA
Contact information
Practice address
1100 SW SAINT LUCIE WEST BLVD STE 207, PORT ST LUCIE, FL 34986-1735
(772) 340-0023
(772) 340-0840
Mailing address
1100 SW SAINT LUCIE WEST BLVD STE 207, PORT ST LUCIE, FL 34986-1735
(772) 340-0023
(772) 340-0840
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN10314
FL
Other
Enumeration date
07/27/2006
Last updated
12/19/2007
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