Organization
DENTAL ASC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG JACOBS D.P.M. (MANAGING MEMBER)
(214) 263-6334
Entity
Organization
Contact information
Practice address
2690 N GALLOWAY AVE, MESQUITE, TX 75150-4857
(972) 279-1200
Mailing address
2690 N GALLOWAY AVE, MESQUITE, TX 75150-4857
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
08/31/2011
Last updated
08/31/2011
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