Individual
MICHAEL L JACOBSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12587 HESPERIA RD, VICTORVILLE, CA 92395-8308
(760) 951-7752
Mailing address
12587 HESPERIA RD, VICTORVILLE, CA 92395-8308
(760) 951-7752
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
30185
CA
Other
Enumeration date
06/15/2022
Last updated
06/15/2022
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