Individual
JACOB ITSKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-2000
Mailing address
6855 LEYTONSTONE BLVD, WEST BLOOMFIELD, MI 48322-1243
(248) 303-5919
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
12877
CT
Other
Enumeration date
03/10/2020
Last updated
08/04/2020
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