Individual
DR. MYKLE A JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1587 VERNON RD, LAGRANGE, GA 30240-4146
(706) 884-2655
(706) 883-7670
Mailing address
1587 VERNON RD, LAGRANGE, GA 30240-4146
(706) 884-2655
(706) 883-7670
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2005012885
MO
Other
Enumeration date
08/20/2006
Last updated
08/11/2020
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