Individual
DR. JACOB HUSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 294-5174
Mailing address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 294-5174
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1001304-15
WI
Other
Enumeration date
08/04/2016
Last updated
08/04/2016
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