Individual
BOYD LEE JACOBSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S.
Contact information
Practice address
1508 E SKYLINE DR, SUITE 100, SOUTH OGDEN, UT 84405-4846
(801) 479-7069
Mailing address
4210 DAISY DR, MOUNTAIN GREEN, UT 84050-9768
(801) 829-5528
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
322036-9923
UT
Other
Enumeration date
08/23/2006
Last updated
07/08/2007
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