Individual
DR. GARY LEE JACOBSEN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
200 N B ST, INDIANOLA, IA 50125-2429
(515) 961-8411
Mailing address
200 N B ST, INDIANOLA, IA 50125-2429
(515) 961-8411
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7648
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0422311
—
IA
Enumeration date
03/20/2006
Last updated
07/08/2007
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