Individual
DR. BENNETT JACOBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2978 HALEKO RD, STE A, LIHUE, HI 96766-1379
(808) 202-2060
Mailing address
PO BOX 75407294, STE. A, SIOUX FALLS, SD 57186-1379
(808) 202-2060
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
DT2112
HI
Other
Enumeration date
06/01/2007
Last updated
11/07/2016
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