Individual
DALE EVERETT JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1411 W SAINT GERMAIN ST, SUITE #103, SAINT CLOUD, MN 56301-4121
(320) 253-2121
Mailing address
1411 W SAINT GERMAIN ST, SUITE #103, SAINT CLOUD, MN 56301-4121
(320) 253-2121
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7680
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7680
DENTAL LICENSE NUMBER
MN
Enumeration date
11/21/2006
Last updated
07/08/2007
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