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Individual

DR. JACOB DANIEL CARLISLE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
800 M 139, BENTON HARBOR, MI 49022-3881
(855) 869-6900
Mailing address
822 SHIP ST APT 5, SAINT JOSEPH, MI 49085-1138

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901600138
MI

Other

Enumeration date
06/13/2019
Last updated
06/13/2019
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