Individual
AMANDA JACOBS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
411 WILLIS ST, TAYLORSVILLE, MS 39168-4550
(601) 785-4770
Mailing address
411 WILLIS ST, TAYLORSVILLE, MS 39168-4550
(601) 785-4770
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3804-15
MS
Other
Enumeration date
06/19/2015
Last updated
06/19/2015
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