Organization
COMPREHENSIVE DENTAL SERVICES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARC JACOBSON DDS (VICE PRESIDENT)
(262) 241-2060
Entity
Organization
Contact information
Practice address
10521 N PORT WASHINGTON RD, SUITE 200, MEQUON, WI 53092
(262) 241-2060
(262) 241-2064
Mailing address
10521 N PORT WASHINGTON RD, SUITE 200, MEQUON, WI 53092
(262) 241-2060
(262) 241-2064
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2475-015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33378400
—
WI
05
—
33412900
—
WI
Enumeration date
12/06/2006
Last updated
08/22/2020
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