Individual
MISS ELLEN DENISE JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
14682 PENNOCK AVENUE SOUTH, APPLE VALLEY, MN 55124
(952) 431-5774
(952) 431-0862
Mailing address
14682 PENNOCK AVENUE SOUTH, APPLE VALLEY, MN 55124
(952) 431-5774
(952) 431-0862
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D13690
MN
Other
Enumeration date
06/03/2016
Last updated
06/03/2016
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